Provider Demographics
NPI:1083803183
Name:ROGHANI, SHIVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:ROGHANI
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 1:13420 NEWPORT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3745
Mailing Address - Country:US
Mailing Address - Phone:714-832-1343
Mailing Address - Fax:
Practice Address - Street 1:13420 NEWPORT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3745
Practice Address - Country:US
Practice Address - Phone:714-832-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry