Provider Demographics
NPI:1851584718
Name:FOROUZAN YAVARI DDS, INC.
Entity Type:Organization
Organization Name:FOROUZAN YAVARI DDS, INC.
Other - Org Name:ALISO PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FOROUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAVARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-362-9888
Mailing Address - Street 1:15 MAREBLU
Mailing Address - Street 2:SUITE #320
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3015
Mailing Address - Country:US
Mailing Address - Phone:949-362-9888
Mailing Address - Fax:
Practice Address - Street 1:15 MAREBLU
Practice Address - Street 2:SUITE #320
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3015
Practice Address - Country:US
Practice Address - Phone:949-362-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445581223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty