Healthcare Provider Details

I. General information

NPI: 1497064992
Provider Name (Legal Business Name): HANI MOHSENZADEH DDS, RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STONY POINT RD
SANTA ROSA CA
95401-4122
US

IV. Provider business mailing address

41 ROYAL GORGE ST
SANTA ROSA CA
95409-4281
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-4500
  • Fax:
Mailing address:
  • Phone: 619-274-5796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107197
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number24498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: