Provider Demographics
NPI:1720273691
Name:EIZADI, ROKHSAR (DDS)
Entity Type:Individual
Prefix:
First Name:ROKHSAR
Middle Name:
Last Name:EIZADI
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 1:7190 SHORELINE DR UNIT 6304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4927
Mailing Address - Country:US
Mailing Address - Phone:858-412-4725
Mailing Address - Fax:
Practice Address - Street 1:318 9TH ST STE C
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2805
Practice Address - Country:US
Practice Address - Phone:858-259-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist