Individual
MAHSA ROOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2941 TWO NOTCH RD, COLUMBIA, SC 29204-1400
(803) 251-2260
Mailing address
2933 HENRY ST APT 54, AUGUSTA, GA 30909-3881
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11143
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/09/2025
Last updated
06/24/2025
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