Provider Demographics
NPI:1932646296
Name:BAKHTIAR-CUMMINS, ROSHAN S (DMD)
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:S
Last Name:BAKHTIAR-CUMMINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MADISON AVE RM 2008
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1664
Mailing Address - Country:US
Mailing Address - Phone:212-421-9757
Mailing Address - Fax:
Practice Address - Street 1:595 MADISON AVE RM 2008
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1664
Practice Address - Country:US
Practice Address - Phone:212-421-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37784122300000X
NY044536-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist