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General NPI Number Information
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NPI Number | 1912255860
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Entity Type | Individual
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Provider Name | TARANEH RAZAVI DDS
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Gender | Female
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 8719 WOODLEY AVE STE B
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City | NORTH HILLS
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State | CA
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Zip | 91343-4729
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Country | US
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Telephone | 818-830-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 17072 ESCALON DR
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City | ENCINO
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State | CA
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Zip | 91436-3838
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Country | US
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Telephone | 310-871-1571
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 61843
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 61843
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License Number State | CA
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