Advanta Dental Group

Primary specialty

DentistTaxonomy code 122300000X

License

42496 Issued in CA

Legal business name

ADVANTA DENTAL GROUP

Practice address

5915 Hollis St Ste a
Emeryville, CA 94608-2066

Phone

(510) 596-9000

Fax

(510) 596-8800

NPI assigned

Nov 21, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Sepideh Razavi, D.D.S

Title

Dentist

Phone

(510) 596-9000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1321833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321833600000",
    "number": "1104193051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 HOLLIS ST STE A",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082066",
            "telephone_number": "510-596-9000",
            "fax_number": "510-596-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 HOLLIS ST STE A",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082066",
            "telephone_number": "510-596-9000",
            "fax_number": "510-596-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTA DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-21",
        "last_updated": "2011-11-21",
        "status": "A",
        "authorized_official_last_name": "RAZAVI",
        "authorized_official_first_name": "SEPIDEH",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "510-596-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "42496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "42496",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• ABA Force
• Elizandra Anaie Abando Delgado
• Mark Abar
• Jeffrey Christopher Abreu, DC
• Emily Abuan
• Anji Namita Agarwal
• Ritu Agarwal
• Agesong Emeryville Owner, LLC (AgeSong at Bayside Park)
• Victoria Aguiar
• Rebecca Toranneasa Ailisheva, LMFT

• Dentist in Emeryville, CA
• Providers in Emeryville, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.