Provider Demographics
NPI:1518630664
Name:BANKOLE, ROSHANAK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:
Last Name:BANKOLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROSHANAK
Other - Middle Name:
Other - Last Name:JAMALZADEHSAHRAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3633 MANZANOLA WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-7846
Mailing Address - Country:US
Mailing Address - Phone:916-910-5186
Mailing Address - Fax:
Practice Address - Street 1:2110 PROFESSIONAL DR STE 115
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3778
Practice Address - Country:US
Practice Address - Phone:916-783-5600
Practice Address - Fax:916-783-5614
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106708122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist