Provider Demographics
NPI:1558604264
Name:KHAJAVI, ROXANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNA
Middle Name:
Last Name:KHAJAVI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 S END AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1014
Mailing Address - Country:US
Mailing Address - Phone:212-786-0930
Mailing Address - Fax:
Practice Address - Street 1:375 S END AVE STE 2B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280
Practice Address - Country:US
Practice Address - Phone:212-786-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0399411223G0001X
NY0583441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice