Provider Demographics
NPI:1477077097
Name:ROSI SHRESTHA, D.M.D., INC.
Entity Type:Organization
Organization Name:ROSI SHRESTHA, D.M.D., INC.
Other - Org Name:CROSSROADS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRESTHA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-326-3657
Mailing Address - Street 1:24231 CRENSHAW BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5344
Mailing Address - Country:US
Mailing Address - Phone:310-326-3657
Mailing Address - Fax:310-326-4299
Practice Address - Street 1:24231 CRENSHAW BLVD STE E
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5344
Practice Address - Country:US
Practice Address - Phone:310-326-3657
Practice Address - Fax:310-326-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58146122300000X, 1223G0001X
CA557151223E0200X
CAA834491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty