Provider Demographics
NPI:1699250837
Name:POGHOSYAN, ROZA (DDS)
Entity type:Individual
Prefix:
First Name:ROZA
Middle Name:
Last Name:POGHOSYAN
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 1:2713 44TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2641
Mailing Address - Country:US
Mailing Address - Phone:415-971-3384
Mailing Address - Fax:
Practice Address - Street 1:2713 44TH AVE APT 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2641
Practice Address - Country:US
Practice Address - Phone:415-971-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1026421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice