Provider Demographics
NPI:1023602885
Name:YAVARI, ROYA (DDS)
Entity type:Individual
Prefix:MRS
First Name:ROYA
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 1:16915 SONOMA RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255
Mailing Address - Country:US
Mailing Address - Phone:949-247-6387
Mailing Address - Fax:
Practice Address - Street 1:3166 SE MILITARY DRIVE
Practice Address - Street 2:B101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223
Practice Address - Country:US
Practice Address - Phone:502-852-3482
Practice Address - Fax:502-852-1317
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX410711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program