Provider Demographics
NPI:1245716083
Name:RASTEGAR, ROSHANAK (DDS)
Entity type:Individual
Prefix:MRS
First Name:ROSHANAK
Middle Name:
Last Name:RASTEGAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 WESTPARK DR APT 1915
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4296
Mailing Address - Country:US
Mailing Address - Phone:205-383-6717
Mailing Address - Fax:
Practice Address - Street 1:135 CONSTON AVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1151
Practice Address - Country:US
Practice Address - Phone:540-385-4501
Practice Address - Fax:205-934-7013
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA01014182291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program