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General NPI Number Information
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NPI Number | 1811138639
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Entity Type | Organization
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Legal Business Name | ROZENOVICH & AUSKER GENERAL PARTNERSHIP
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 2720 S BRISTOL ST STE 104
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City | SANTA ANA
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State | CA
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Zip | 92704-6210
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Country | US
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Telephone | 714-549-1409
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Fax | 714-549-2118
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Provider Business Mailing Address
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Address Line | 2720 S BRISTOL ST STE 104
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City | SANTA ANA
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State | CA
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Zip | 92704-6210
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Country | US
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Telephone | 714-549-1409
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Fax | 714-549-2118
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Authorized Official
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Title or Position | PARTNER
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Name | GRIGORY ROZENOVICH
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Credential | DDS
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Telephone | 714-549-1409
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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 | 55624
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40115
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License Number State | CA
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