Provider Demographics
NPI:1326215013
Name:EMAM, ROUSHANAK (DDS)
Entity Type:Individual
Prefix:
First Name:ROUSHANAK
Middle Name:
Last Name:EMAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ROSHAN
Other - Middle Name:
Other - Last Name:EMAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:703 WELCH ROAD
Mailing Address - Street 2:#A1
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-321-0340
Mailing Address - Fax:650-321-1879
Practice Address - Street 1:703 WELCH ROAD
Practice Address - Street 2:#A1
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-321-0340
Practice Address - Fax:650-321-1879
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice