MEDICARE: DR. SARA TANAVOLI DDS,MS

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	1223P0300X	Periodontics	48684	CA

General Provider Information

NPI Number	:	1902961949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA TANAVOLI DDS,MS

Provider Business Mailing Address
First Line	:	6325 TOPANGA CANYON BLVD STE 202
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2015
Country	:	US
Telephone Number	:	818-703-7733
Fax Number	:

Provider Business Practice Location Address
First Line	:	6325 TOPANGA CANYON BLVD STE 202
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2015
Country	:	US
Telephone Number	:	818-703-7733
Fax Number	:

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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