Provider Demographics
NPI:1285452557
Name:ROOTED PEDIATRIC DENTAL
Entity type:Organization
Organization Name:ROOTED PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARZIDEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-455-3308
Mailing Address - Street 1:7 WOODCLEFT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2736
Mailing Address - Country:US
Mailing Address - Phone:516-455-3308
Mailing Address - Fax:
Practice Address - Street 1:265 POST AVE STE 380
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2234
Practice Address - Country:US
Practice Address - Phone:516-738-4434
Practice Address - Fax:516-738-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty