Provider Demographics
NPI:1457516197
Name:ROUINTAN, MITRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITRA
Middle Name:
Last Name:ROUINTAN
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 1:9209 COLIMA RD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605
Mailing Address - Country:US
Mailing Address - Phone:562-693-4108
Mailing Address - Fax:562-698-3671
Practice Address - Street 1:9209 COLIMA RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605
Practice Address - Country:US
Practice Address - Phone:562-693-4108
Practice Address - Fax:562-698-3671
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice