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General NPI Number Information
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NPI Number | 1932410420
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Entity Type | Individual
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Provider Name | FIONA M TAVAKOLI DMD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 5601 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3074
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Country | US
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Telephone | 619-462-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 13478 CHELAN CT
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City | SAN DIEGO
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State | CA
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Zip | 92129-4434
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Country | US
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Telephone | 904-859-8804
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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 | 18890
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 63528
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License Number State | CA
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