Provider Demographics
NPI:1023520087
Name:KALRA, ROSHAN NARESH (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:NARESH
Last Name:KALRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N WALKER AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-6408
Mailing Address - Country:US
Mailing Address - Phone:813-500-1541
Mailing Address - Fax:
Practice Address - Street 1:7100 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5234
Practice Address - Country:US
Practice Address - Phone:405-241-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22882122300000X
OK6990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist