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NPI Code Detail

MEDICARE: DR. JOHN S ROKHSARZADEH D.D.S.

MEDICARE: DR. JOHN S ROKHSARZADEH D.D.S.
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
1122300000XDentist4844NV

General Provider Information

NPI Number : 1629293576
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN S ROKHSARZADEH D.D.S.
Provider Business Mailing Address
First Line : 6136 W SAHARA AVE
Second Line : LAS VEGAS CENTER FOR COSMETIC DENTISTRY
City : LAS VEGAS
State : NV
Zip : 89146-3051
Country : US
Telephone Number : 702-362-9353
Fax Number : 702-362-1747
Provider Business Practice Location Address
First Line : 6136 W SAHARA AVE
Second Line : LAS VEGAS CENTER FOR COSMETIC DENTISTRY
City : LAS VEGAS
State : NV
Zip : 89146-3051
Country : US
Telephone Number : 702-362-9353
Fax Number : 702-362-1747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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