Provider Demographics
NPI:1245801190
Name:HAKAMI-TAFRESHI, ROXAN (DDS)
Entity Type:Individual
Prefix:
First Name:ROXAN
Middle Name:
Last Name:HAKAMI-TAFRESHI
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 1:15795 DOVEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2282
Mailing Address - Country:US
Mailing Address - Phone:414-204-2515
Mailing Address - Fax:
Practice Address - Street 1:3318 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4424
Practice Address - Country:US
Practice Address - Phone:661-214-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist