Provider Demographics
NPI:1467519140
Name:DAVARI, HAMLET (DDS)
Entity Type:Individual
Prefix:
First Name:HAMLET
Middle Name:
Last Name:DAVARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N BRAND BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2567
Mailing Address - Country:US
Mailing Address - Phone:818-242-4781
Mailing Address - Fax:
Practice Address - Street 1:607 N CENTRAL AVE
Practice Address - Street 2:301
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1804
Practice Address - Country:US
Practice Address - Phone:818-242-4781
Practice Address - Fax:818-242-4147
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB428161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice