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General NPI Number Information
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NPI Number | 1770930869
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Entity Type | Organization
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Legal Business Name | AVA DENTAL GROUP INC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 160 ALAMO PLZ #203
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City | ALAMO
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State | CA
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Zip | 94507-4001
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Country | US
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Telephone | 602-570-7123
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Fax |
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Provider Business Mailing Address
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Address Line | 6684 ALHAMBRA AVE
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City | MARTINEZ
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State | CA
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Zip | 94553-6105
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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 | PRESIDENT
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Name | DR. RAMIN SANI
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Credential |
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Telephone | 602-570-7123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 54654
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License Number State | CA
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