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General NPI Number Information
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NPI Number | 1396866000
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Entity Type | Organization
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Legal Business Name | ROYA MIRKHAN, DMD, MSD, INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 12395 EL CAMINO REAL SUITE #314
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City | SAN DIEGO
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State | CA
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Zip | 92130-3082
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Country | US
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Telephone | 858-337-6264
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Fax | 858-755-6260
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Provider Business Mailing Address
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Address Line | 12395 EL CAMINO REAL SUITE #314
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City | SAN DIEGO
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State | CA
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Zip | 92130-3082
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Country | US
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Telephone | 858-337-6264
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Fax | 858-755-6260
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROYA NAZILA MIRKHAN
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Credential | DMD, MSD
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Telephone | 858-337-6264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 44743
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License Number State | CA
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