Provider Demographics
NPI:1609568393
Name:BAFIA, ROKSANA VICTORIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROKSANA
Middle Name:VICTORIA
Last Name:BAFIA
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 1:711 N LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1520
Mailing Address - Country:US
Mailing Address - Phone:630-802-9602
Mailing Address - Fax:
Practice Address - Street 1:6941 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2330
Practice Address - Country:US
Practice Address - Phone:773-586-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0342051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice