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NPI Code Detail

MEDICARE: ROZITA BAHADORI DDS

MEDICARE: ROZITA BAHADORI DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry52242CA

General Provider Information

NPI Number : 1346325511
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROZITA BAHADORI DDS
Provider Business Mailing Address
First Line : 726 BOWEN CT
Second Line :
City : SAN RAMON
State : CA
Zip : 94582-5699
Country : US
Telephone Number : 925-829-3006
Fax Number :
Provider Business Practice Location Address
First Line : 2990 W GRANT LINE RD
Second Line :
City : TRACY
State : CA
Zip : 95304-7901
Country : US
Telephone Number : 209-830-7797
Fax Number : 209-830-6842
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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Directions to “ ROZITA BAHADORI DDS” Practice Location

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