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General NPI Number Information
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NPI Number | 1720444573
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Entity Type | Individual
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Provider Name | NIOUSHA ANVARI DMD
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Gender | Female
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Dates
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Enumeration Date | 01/09/2016
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 190 11TH ST
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City | OAKLAND
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State | CA
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Zip | 94607-4841
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Country | US
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Telephone | 510-250-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 187 MIRAMONTE DR
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City | MORAGA
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State | CA
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Zip | 94556-1003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 106927
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License Number State | CA
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