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General NPI Number Information
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NPI Number | 1538266499
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Entity Type | Individual
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Provider Name | SIAMAK OKHOVAT DDS
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 2110 PROFESSIONAL DR SUITE 115
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City | ROSEVILLE
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State | CA
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Zip | 95661-3752
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Country | US
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Telephone | 916-783-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 7136 ARTISAN CIR
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City | ROSEVILLE
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State | CA
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Zip | 95678-2906
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Country | US
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Telephone | 916-765-2054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 47541
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License Number State | CA
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