Provider Demographics
NPI:1629293576
Name:ROKHSARZADEH, JOHN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:ROKHSARZADEH
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 1:6136 W SAHARA AVE
Mailing Address - Street 2:LAS VEGAS CENTER FOR COSMETIC DENTISTRY
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3051
Mailing Address - Country:US
Mailing Address - Phone:702-362-9353
Mailing Address - Fax:702-362-1747
Practice Address - Street 1:6136 W SAHARA AVE
Practice Address - Street 2:LAS VEGAS CENTER FOR COSMETIC DENTISTRY
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3051
Practice Address - Country:US
Practice Address - Phone:702-362-9353
Practice Address - Fax:702-362-1747
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist