Provider Demographics
NPI:1407862667
Name:ROODZANT, GERALD PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PAUL
Last Name:ROODZANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15071 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1302
Mailing Address - Country:US
Mailing Address - Phone:562-943-2995
Mailing Address - Fax:562-943-7245
Practice Address - Street 1:11311 LA MIRADA BLVD STE C
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604
Practice Address - Country:US
Practice Address - Phone:562-944-2995
Practice Address - Fax:562-946-6959
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice