Provider Demographics
NPI:1780863266
Name:NEMATOLLAHI, ROYA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ROYA
Middle Name:
Last Name:NEMATOLLAHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14122 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5834
Mailing Address - Country:US
Mailing Address - Phone:714-544-8338
Mailing Address - Fax:714-573-1062
Practice Address - Street 1:14122 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-544-8338
Practice Address - Fax:714-573-1062
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541811223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice