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NPI Code Detail

MEDICARE: ROXANA GHADERI

MEDICARE: ROXANA GHADERI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDEN.00205638CO
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1063112910
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROXANA GHADERI
Provider Business Mailing Address
First Line : 3705 E COLFAX AVE # 101
Second Line :
City : DENVER
State : CO
Zip : 80206-1810
Country : US
Telephone Number : 303-399-3001
Fax Number :
Provider Business Practice Location Address
First Line : 3705 E COLFAX AVE # 101
Second Line :
City : DENVER
State : CO
Zip : 80206-1810
Country : US
Telephone Number : 303-399-3001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2023
Last Update Date : 06/14/2023

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Directions to “ ROXANA GHADERI ” Practice Location

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