Provider Demographics
NPI:1336483411
Name:ROUHANI AND ASSOCIATES DDS, PLLC
Entity Type:Organization
Organization Name:ROUHANI AND ASSOCIATES DDS, PLLC
Other - Org Name:BRIGHT SMILES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-661-4077
Mailing Address - Street 1:801 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2541
Mailing Address - Country:US
Mailing Address - Phone:919-661-4077
Mailing Address - Fax:919-661-4078
Practice Address - Street 1:801 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2541
Practice Address - Country:US
Practice Address - Phone:919-661-4077
Practice Address - Fax:919-661-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912911Medicaid