Provider Demographics
NPI:1023401858
Name:ROSITA M RAYHAN DDS
Entity Type:Organization
Organization Name:ROSITA M RAYHAN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-931-3881
Mailing Address - Street 1:6200 WILSHIRE BLVD STE 1110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5812
Mailing Address - Country:US
Mailing Address - Phone:323-931-3881
Mailing Address - Fax:
Practice Address - Street 1:6200 WILSHIRE BLVD STE 1110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5812
Practice Address - Country:US
Practice Address - Phone:323-931-3881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAYHAN & MARVIZI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty