MEDICARE: JARDOSH DDS DENTAL PROFESSIONAL CORP

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1417849720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JARDOSH DDS DENTAL PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	8016 PRIVET LN
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90241-6011
Country	:	US
Telephone Number	:	865-406-7393
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 CENTER AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2524
Country	:	US
Telephone Number	:	865-406-7393
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROSHAN R JARDOSH
Credential	:	DDS
Telephone Number	:	865-406-7393

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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