Provider Demographics
NPI:1437278405
Name:MAZDAEI, ROEYA (DDS)
Entity type:Individual
Prefix:DR
First Name:ROEYA
Middle Name:
Last Name:MAZDAEI
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 1:308 W LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1826
Mailing Address - Country:US
Mailing Address - Phone:805-531-0022
Mailing Address - Fax:805-517-1124
Practice Address - Street 1:308 W LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1826
Practice Address - Country:US
Practice Address - Phone:805-531-0022
Practice Address - Fax:805-517-1124
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38328-01OtherMEDICAL PROVIDER NUMBER