Healthcare Provider Details

I. General information

NPI: 1134825524
Provider Name (Legal Business Name): ROKHSAREH HASSANZADEHMAHAEI DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR PH SOUTH
BEVERLY HILLS CA
90210-5011
US

IV. Provider business mailing address

831 S GRETNA GREEN WAY APT 302
LOS ANGELES CA
90049-5270
US

V. Phone/Fax

Practice location:
  • Phone: 424-421-4292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ROXANNE SALAVATI
Title or Position: DENTIST
Credential: DMD
Phone: 424-421-4292