Provider Demographics
NPI:1295249316
Name:MAVI, JASNENA (DDS)
Entity type:Individual
Prefix:DR
First Name:JASNENA
Middle Name:
Last Name:MAVI
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 1:3093 BROADWAY UNIT 632
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5952
Mailing Address - Country:US
Mailing Address - Phone:734-709-0755
Mailing Address - Fax:
Practice Address - Street 1:5167 CLAYTON RD STE D
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3163
Practice Address - Country:US
Practice Address - Phone:925-254-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022406122300000X
CA1074311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist