Provider Demographics
NPI:1710748579
Name:ROLLOLAZO DENTAL STUDIO
Entity Type:Organization
Organization Name:ROLLOLAZO DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PARHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-833-3756
Mailing Address - Street 1:2131 WESTCLIFF DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5545
Mailing Address - Country:US
Mailing Address - Phone:949-833-3756
Mailing Address - Fax:949-752-5124
Practice Address - Street 1:2131 WESTCLIFF DR STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5545
Practice Address - Country:US
Practice Address - Phone:949-833-3756
Practice Address - Fax:949-752-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty