Provider Demographics
NPI:1447361670
Name:RAMEZANI, ROXANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:
Last Name:RAMEZANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 RIDGE RUN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-6134
Mailing Address - Country:US
Mailing Address - Phone:415-310-0405
Mailing Address - Fax:
Practice Address - Street 1:11721 RIDGE RUN WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-6134
Practice Address - Country:US
Practice Address - Phone:415-310-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice