Provider Demographics
NPI:1295947760
Name:HAGHSHENAS, ROSHANAK (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSHANAK
Middle Name:
Last Name:HAGHSHENAS
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 1:7940 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-5773
Mailing Address - Country:US
Mailing Address - Phone:424-429-9107
Mailing Address - Fax:
Practice Address - Street 1:7940 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5773
Practice Address - Country:US
Practice Address - Phone:424-429-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22418122300000X
CA103446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175689203Medicaid
TX175689202Medicaid