Provider Demographics
NPI:1891816658
Name:MIRKHAN, ROYA NAZILA (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:ROYA
Middle Name:NAZILA
Last Name:MIRKHAN
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 POMERADO RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2068
Mailing Address - Country:US
Mailing Address - Phone:858-676-1010
Mailing Address - Fax:858-592-0658
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE #200
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-676-1010
Practice Address - Fax:858-592-0658
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics