Individual
DR. ROSHANAK DEZFOOLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
714 CHASE PKWY STE 2A, WATERBURY, CT 06708-3163
(203) 757-1455
(203) 757-2953
Mailing address
120 LITTLE FOX LN, SOUTHBURY, CT 06488-4640
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
011303
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004011136
—
CT
Enumeration date
06/27/2014
Last updated
06/11/2019
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