Provider Demographics
NPI:1851929707
Name:M YAVARI DDS PC
Entity Type:Organization
Organization Name:M YAVARI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TIN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANSOUREH
Authorized Official - Middle Name:
Authorized Official - Last Name:YAVARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-552-3200
Mailing Address - Street 1:909 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3855
Mailing Address - Country:US
Mailing Address - Phone:619-552-3200
Mailing Address - Fax:
Practice Address - Street 1:909 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3855
Practice Address - Country:US
Practice Address - Phone:619-552-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56898OtherDENTIST