Provider Demographics
NPI:1427229848
Name:HOSEIN BAVAFA
Entity Type:Organization
Organization Name:HOSEIN BAVAFA
Other - Org Name:ELMWOOD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSEIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAVAFA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-883-9373
Mailing Address - Street 1:2620 ASHBY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:510-883-9373
Mailing Address - Fax:510-883-9372
Practice Address - Street 1:2620 ASHBY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-883-9373
Practice Address - Fax:510-883-9372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty