MEDICARE: DR. JASNENA MAVI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901022406	MI
2	1223P0221X	Pediatric Dentistry	107431	CA

General Provider Information

NPI Number	:	1295249316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASNENA MAVI DDS

Provider Business Mailing Address
First Line	:	3093 BROADWAY UNIT 632
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5952
Country	:	US
Telephone Number	:	734-709-0755
Fax Number	:

Provider Business Practice Location Address
First Line	:	5167 CLAYTON RD STE D
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94521-3163
Country	:	US
Telephone Number	:	925-254-4777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	02/08/2023

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