Provider Demographics
NPI:1992868038
Name:ROGER ESHAGHIAN DDS INC
Entity Type:Organization
Organization Name:ROGER ESHAGHIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHAGHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-278-1212
Mailing Address - Street 1:1941 N ROSE AVE
Mailing Address - Street 2:STE 820
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036
Mailing Address - Country:US
Mailing Address - Phone:805-278-1212
Mailing Address - Fax:805-988-3265
Practice Address - Street 1:1941 N ROSE AVE
Practice Address - Street 2:STE 820
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-278-1212
Practice Address - Fax:805-988-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40583Medicaid