Provider Demographics
NPI:1467607341
Name:KASROVI, PAUL M (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:KASROVI
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Gender:M
Credentials:DDS,MS
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Mailing Address - Street 1:2640 TELEGRAPH AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3374
Mailing Address - Country:US
Mailing Address - Phone:510-204-8855
Mailing Address - Fax:510-898-1691
Practice Address - Street 1:96 DAVIS RD
Practice Address - Street 2:SUITE #1
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3041
Practice Address - Country:US
Practice Address - Phone:510-204-8855
Practice Address - Fax:510-548-8438
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2013-09-12
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Provider Licenses
StateLicense IDTaxonomies
CA0000403621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics