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Organization
SOPHIA ROZOV DDS, INC
Active
Organization
SOPHIA ROZOV DDS, INC
Active
Other names
Smile Avenue Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SOPHIA ROZOV DDS (CEO)
(562) 904-0400
Entity
Organization
Contact information
Practice address
8543 ROSEMEAD BLVD, # D, PICO RIVERA, CA 90660-5427
(562) 904-0400
(562) 904-1803
Mailing address
5640 ETIWANDA AVE, # 5, TARZANA, CA 91356-2700
(562) 904-0400
(562) 904-1803
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
45820
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-45820
DELTA-DENTAL
CA
01
—
G93356-01
DENTI-CAL
CA
Enumeration date
03/20/2007
Last updated
01/22/2016
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