Provider Demographics
NPI:1013926989
Name:BEIZAI, ROUHI (DDS)
Entity type:Individual
Prefix:MRS
First Name:ROUHI
Middle Name:
Last Name:BEIZAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ROUHANGIZ
Other - Middle Name:
Other - Last Name:BEIZAIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1307 W 6TH ST
Mailing Address - Street 2:SUITE #113
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3294
Mailing Address - Country:US
Mailing Address - Phone:951-278-8910
Mailing Address - Fax:951-278-9895
Practice Address - Street 1:1307 W 6TH ST
Practice Address - Street 2:STE 113
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3168
Practice Address - Country:US
Practice Address - Phone:951-278-8910
Practice Address - Fax:951-278-9895
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice