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General NPI Number Information
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NPI Number | 1427229848
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Entity Type | Organization
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Legal Business Name | HOSEIN BAVAFA
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 2620 ASHBY AVE SUITE 201
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City | BERKELEY
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State | CA
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Zip | 94705
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Country | US
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Telephone | 510-883-9373
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Fax | 510-883-9372
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Provider Business Mailing Address
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Address Line | 2620 ASHBY AVE SUITE 201
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City | BERKELEY
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State | CA
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Zip | 94705
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Country | US
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Telephone | 510-883-9373
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Fax | 510-883-9372
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HOSEIN S BAVAFA
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Credential | DDS
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Telephone | 510-883-9373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44806
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License Number State | CA
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