Healthcare Provider Details

I. General information

NPI: 1134034796
Provider Name (Legal Business Name): ROSHAN ZOHA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 LOWER SACRAMENTO RD STE B
STOCKTON CA
95210-3747
US

IV. Provider business mailing address

10270 E TARON DR APT 28
ELK GROVE CA
95757-8227
US

V. Phone/Fax

Practice location:
  • Phone: 209-336-8478
  • Fax:
Mailing address:
  • Phone: 424-371-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: