Provider Demographics
NPI:1225574353
Name:ROXANNA BAGHAI DDS. INC
Entity Type:Organization
Organization Name:ROXANNA BAGHAI DDS. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-554-8454
Mailing Address - Street 1:2500 ALTON PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5032
Mailing Address - Country:US
Mailing Address - Phone:949-554-8454
Mailing Address - Fax:
Practice Address - Street 1:2500 ALTON PKWY STE 110
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5032
Practice Address - Country:US
Practice Address - Phone:949-554-8454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty