Provider Demographics
NPI:1891162624
Name:ROUZBEH VOSSOUGHI DDS PC
Entity Type:Organization
Organization Name:ROUZBEH VOSSOUGHI DDS PC
Other - Org Name:SYLMAR ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROUZBEH
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSSOUGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-806-1599
Mailing Address - Street 1:13910 FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3014
Mailing Address - Country:US
Mailing Address - Phone:310-806-1599
Mailing Address - Fax:
Practice Address - Street 1:13910 FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3014
Practice Address - Country:US
Practice Address - Phone:310-806-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty