Provider Demographics
NPI:1225352974
Name:NIKFAR, ROSANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSANA
Middle Name:
Last Name:NIKFAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 WINEGARD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4977
Mailing Address - Country:US
Mailing Address - Phone:407-749-0113
Mailing Address - Fax:
Practice Address - Street 1:6161 WINEGARD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4977
Practice Address - Country:US
Practice Address - Phone:407-749-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014126521223G0001X
FLDN196181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice