Provider Demographics
NPI:1689152985
Name:ROHANIDEZFOOLI, HOSSEIN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:
Last Name:ROHANIDEZFOOLI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:HOSS
Other - Middle Name:
Other - Last Name:ROHANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:11415 SPECTRUM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3431
Mailing Address - Country:US
Mailing Address - Phone:949-413-6601
Mailing Address - Fax:
Practice Address - Street 1:2240 N HARBOR BLVD STE 220
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2637
Practice Address - Country:US
Practice Address - Phone:714-459-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0255541223G0001X
CA1093951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice