Provider Demographics
NPI:1871486126
Name:ROSHANAK MOMEN DENTAL INC
Entity type:Organization
Organization Name:ROSHANAK MOMEN DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSHANAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-404-4217
Mailing Address - Street 1:26302 LA PAZ RD STE 210
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5328
Mailing Address - Country:US
Mailing Address - Phone:949-818-4884
Mailing Address - Fax:
Practice Address - Street 1:26302 LA PAZ RD STE 210
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5328
Practice Address - Country:US
Practice Address - Phone:949-818-4884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty