Provider Demographics
NPI:1376688663
Name:ROZOV, SOPHIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:
Last Name:ROZOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:BASIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5640 ETIWANDA AVE
Mailing Address - Street 2:#5
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2700
Mailing Address - Country:US
Mailing Address - Phone:818-635-9141
Mailing Address - Fax:818-705-7940
Practice Address - Street 1:19233 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3122
Practice Address - Country:US
Practice Address - Phone:818-705-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice