Provider Demographics
NPI:1114477239
Name:ROOINTAN, MEHRAN
Entity Type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:
Last Name:ROOINTAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N LOUISE ST
Mailing Address - Street 2:APT# 207
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-2052
Mailing Address - Country:US
Mailing Address - Phone:949-903-8533
Mailing Address - Fax:
Practice Address - Street 1:950 N LOUISE ST
Practice Address - Street 2:APT# 207
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2052
Practice Address - Country:US
Practice Address - Phone:949-903-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist