Provider Demographics
NPI:1508146713
Name:MASCARENHAS, ROMOLA FRANCESCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROMOLA
Middle Name:FRANCESCA
Last Name:MASCARENHAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROMOLA
Other - Middle Name:FRANCESCA
Other - Last Name:D'SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2103 MONTROSE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1546
Mailing Address - Country:US
Mailing Address - Phone:818-248-1718
Mailing Address - Fax:818-248-1703
Practice Address - Street 1:2103 MONTROSE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1546
Practice Address - Country:US
Practice Address - Phone:818-248-1718
Practice Address - Fax:818-248-1703
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist