Provider Demographics
NPI:1821466111
Name:ROZHAVSKY, MARINA ZATS (DDS)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:ZATS
Last Name:ROZHAVSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:ZATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:20 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1409
Mailing Address - Country:US
Mailing Address - Phone:650-701-1111
Mailing Address - Fax:650-701-0960
Practice Address - Street 1:20 BIRCH ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1409
Practice Address - Country:US
Practice Address - Phone:650-701-1111
Practice Address - Fax:650-701-0960
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645811223G0001X
CA24639124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No124Q00000XDental ProvidersDental Hygienist