Provider Demographics
NPI:1447024526
Name:RAD, ROYA HASHEMI (DDS)
Entity type:Individual
Prefix:
First Name:ROYA
Middle Name:HASHEMI
Last Name:RAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ROYA
Other - Middle Name:
Other - Last Name:RAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2970 NEAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3331
Mailing Address - Country:US
Mailing Address - Phone:310-857-9077
Mailing Address - Fax:
Practice Address - Street 1:2970 NEAL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3331
Practice Address - Country:US
Practice Address - Phone:310-857-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1093881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty