Provider Demographics
NPI:1124382817
Name:ROSHANAEI DENTAL CORPORATION
Entity type:Organization
Organization Name:ROSHANAEI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHANAEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-252-3533
Mailing Address - Street 1:27552 SIERRA HWY
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3088
Mailing Address - Country:US
Mailing Address - Phone:661-252-3533
Mailing Address - Fax:
Practice Address - Street 1:27552 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3088
Practice Address - Country:US
Practice Address - Phone:661-252-3533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty