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General NPI Number Information
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NPI Number | 1871107102
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Entity Type | Organization
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Legal Business Name | OFFICE OF DR. PAKRAVAN DDS, INC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 2136 UNIVERSITY AVE
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City | BERKELEY
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State | CA
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Zip | 94704-1026
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Country | US
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Telephone | 510-548-3368
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Fax | 510-259-2496
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Provider Business Mailing Address
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Address Line | 2136 UNIVERSITY AVE
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City | BERKELEY
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State | CA
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Zip | 94704-1026
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Country | US
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Telephone | 510-548-3368
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Fax | 510-259-2496
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY NEEDHAM
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Credential | DDS
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Telephone | 510-548-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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