Healthcare Provider Details

I. General information

NPI: 1396883237
Provider Name (Legal Business Name): LEON D ROISMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LAKE AVE LOWER LEVEL
PASADENA CA
91101-3540
US

IV. Provider business mailing address

310 S LAKE AVE LOWER LEVEL
PASADENA CA
91101-3540
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-6855
  • Fax: 626-432-4270
Mailing address:
  • Phone: 626-795-6855
  • Fax: 626-432-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number19960
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: