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General NPI Number Information
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NPI Number | 1184749392
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Entity Type | Organization
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Legal Business Name | SOPHIA ROZOV DDS, INC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 19233 VENTURA BLVD
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City | TARZANA
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State | CA
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Zip | 91356-3122
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Country | US
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Telephone | 818-635-9141
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Fax | 818-705-7940
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Provider Business Mailing Address
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Address Line | 5640 ETIWANDA AVE # 5
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City | TARZANA
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State | CA
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Zip | 91356-2700
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Country | US
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Telephone | 818-705-7900
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Fax | 818-705-7940
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Authorized Official
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Title or Position | CEO
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Name | DR. SOPHIA ROZOV
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Credential | DDS
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Telephone | 818-705-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45820
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License Number State | CA
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