Provider Demographics
NPI:1336494392
Name:ROSHANZAMIR, ROSHANAK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:
Last Name:ROSHANZAMIR
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 1:4765 CARMEL MOUNTAIN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6657
Mailing Address - Country:US
Mailing Address - Phone:858-259-4765
Mailing Address - Fax:
Practice Address - Street 1:4765 CARMEL MOUNTAIN RD STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6657
Practice Address - Country:US
Practice Address - Phone:858-259-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA614921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice