MEDICARE: DR. AMIR A YAVARI 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	1223G0001X	General Practice Dentistry	63835	CA
2	1223G0001X	General Practice Dentistry	30325	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30325	OTHER	TX	TEXAS STATE BOARD OF DENTAL EXAMINERS
2	63835	OTHER	CA	DENTAL BOARD OF CALIFORNIA

General Provider Information

NPI Number	:	1790194561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR A YAVARI DDS

Provider Business Mailing Address
First Line	:	12444 EDGEMERE BLVD STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4445
Country	:	US
Telephone Number	:	915-286-2522
Fax Number	:	915-222-5077

Provider Business Practice Location Address
First Line	:	12444 EDGEMERE BLVD STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4445
Country	:	US
Telephone Number	:	915-286-2522
Fax Number	:	915-222-5077

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	04/06/2026

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