Provider Demographics
NPI:1528240587
Name:ROFAGHA, ROSHANAK (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:
Last Name:ROFAGHA
Suffix:
Gender:F
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:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91012-1037
Mailing Address - Country:US
Mailing Address - Phone:818-926-1813
Mailing Address - Fax:818-249-1061
Practice Address - Street 1:530 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4525
Practice Address - Country:US
Practice Address - Phone:818-926-1813
Practice Address - Fax:818-249-1061
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist