Roshanak Dezfoolian, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

011303 Issued in CT

Practice address

714 Chase Pkwy Ste 2a
Waterbury, CT 06708-3163

Phone

(203) 757-1455

Fax

(203) 757-2953

NPI assigned

Jun 27, 2014

Last updated

Jun 11, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1952716003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 LITTLE FOX LN",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064884640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 CHASE PKWY STE 2A",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083163",
            "telephone_number": "203-757-1455",
            "fax_number": "203-757-2953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEZFOOLIAN",
        "first_name": "ROSHANAK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-27",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "011303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004011136",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Waterbury, CT
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• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.