=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457560518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT RAMTIN ROUHANI D.D.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 05/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13402 N SCOTTSDALE RD SUITE A110
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-951-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8126 E APPALOOSA TRL
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-998-3334
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D5469
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------