Mark Majid Tavakoli, DDS., MS.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

39568 Issued in CA

Practice address

310 N Civic Dr Apt 501
Walnut Creek, CA 94596-3694

Phone

(925) 285-2125

NPI assigned

Oct 9, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mark Tavakoli DDS Dental Corporation

  dba Mark Tavakoli DDs Dental Corp

  • Dental Clinic/Center
  • Oakland, CA
  • NPI 1528715570

  Multi-Specialty

  Medicare reassignment NPD Authorized official
• Mark Tavakoli DDS Dental Corporation

  • Dentist
  • Oakland, CA
  • NPI 1972444115

  Multi-Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1013482868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N CIVIC DR APT 501",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945963694",
            "telephone_number": "925-285-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N CIVIC DR APT 501",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945963694",
            "telephone_number": "925-285-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVAKOLI",
        "first_name": "MARK",
        "middle_name": "MAJID",
        "name_prefix": "Dr.",
        "credential": "DDS., MS.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-09",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "39568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nariah Tarap
• Gerald L Tarder, M.D.
• Adeline Tran Tarr, DO
• Angela Tate-Agnew
• Tatyana Yashchuk (Golden State Dentistry)
• Josh Taves, LAC
• Stacy Janel Taylor Linder, LMFT
• Alicia Taylor
• Brian Douglas Taylor, CRNA
• Camilla Taylor

• Orthodontics and Dentofacial Orthopedics Dentistry in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.