Provider Demographics
NPI:1609067586
Name:ESHAGHIAN, ROGER (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:ESHAGHIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 N ROSE AVE
Mailing Address - Street 2:820
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0654
Mailing Address - Country:US
Mailing Address - Phone:805-278-1212
Mailing Address - Fax:805-988-3265
Practice Address - Street 1:1941 N ROSE AVE
Practice Address - Street 2:SUITE 820
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0654
Practice Address - Country:US
Practice Address - Phone:805-278-1212
Practice Address - Fax:805-988-3265
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40583Medicaid