Provider Demographics
NPI:1790820561
Name:RAZAVI, ERIC (DDS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:RAZAVI
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 1:1225 M ST
Mailing Address - Street 2:JAIL MEDICAL SERVICES, 2ND FLOOR
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1805
Mailing Address - Country:US
Mailing Address - Phone:559-488-2867
Mailing Address - Fax:559-488-3298
Practice Address - Street 1:1225 M ST
Practice Address - Street 2:JAIL MEDICAL SERVICES, 2ND FLOOR
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1805
Practice Address - Country:US
Practice Address - Phone:559-488-2867
Practice Address - Fax:559-488-3298
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist