Provider Demographics
NPI:1659504744
Name:AVANTI DENTAL GROUP INC
Entity Type:Organization
Organization Name:AVANTI DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANIJEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYESTEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-266-4100
Mailing Address - Street 1:5415 CAMDEN AVE
Mailing Address - Street 2:STE#35
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-5827
Mailing Address - Country:US
Mailing Address - Phone:408-266-4100
Mailing Address - Fax:408-266-4106
Practice Address - Street 1:5415 CAMDEN AVE
Practice Address - Street 2:35
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5827
Practice Address - Country:US
Practice Address - Phone:408-266-4100
Practice Address - Fax:408-266-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty