Provider Demographics
NPI:1609998319
Name:YAVARI, FOROUZAN (DDS)
Entity Type:Individual
Prefix:
First Name:FOROUZAN
Middle Name:
Last Name:YAVARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MAREBLU
Mailing Address - Street 2:STE #320
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3047
Mailing Address - Country:US
Mailing Address - Phone:949-362-9888
Mailing Address - Fax:949-362-9222
Practice Address - Street 1:15 MAREBLUE
Practice Address - Street 2:STE #320
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3047
Practice Address - Country:US
Practice Address - Phone:949-362-9888
Practice Address - Fax:949-362-9222
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44558122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist