=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649111261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ROYA NIAKIANI DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2026
-----------------------------------------------------
Last Update Date | 04/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4428 CONVOY STREET, STE 230
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-573-2833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4428 CONVOY STREET, STE 230
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-573-2833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWN/PRESIDENT
-----------------------------------------------------
Name | DR. ROYA NIAKIANI
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 858-573-2833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------