Provider Demographics
NPI:1346325511
Name:BAHADORI, ROZITA (DDS)
Entity Type:Individual
Prefix:
First Name:ROZITA
Middle Name:
Last Name:BAHADORI
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 1:726 BOWEN CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5699
Mailing Address - Country:US
Mailing Address - Phone:925-829-3006
Mailing Address - Fax:
Practice Address - Street 1:2990 W GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-7901
Practice Address - Country:US
Practice Address - Phone:209-830-7797
Practice Address - Fax:209-830-6842
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA522421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice