Organization
GRIGORY ROZENVICH D.D.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRIGORY ROZENOVICH (PRESIDENT)
(714) 549-1409
Entity
Organization
Contact information
Practice address
3620 S. BRISTOL ST., SUITE 210, SANTA ANA, CA 92704
(714) 549-1409
(714) 549-2118
Mailing address
3620 S. BRISTOL ST., SUITE 210, SANTA ANA, CA 92704
(714) 549-1409
(714) 549-2118
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
40115
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7120
PACIFICARE
CA
01
—
973695
UNITED CONCORDIA
PA
01
—
B40115 01
STATE OF CA. DENTI-CAL
CA
Enumeration date
10/23/2007
Last updated
05/06/2015
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