Provider Demographics
NPI:1043197932
Name:ROGHANY, BAHARAK
Entity type:Individual
Prefix:
First Name:BAHARAK
Middle Name:
Last Name:ROGHANY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 W RUSSELL RD UNIT 2068
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1822
Mailing Address - Country:US
Mailing Address - Phone:702-347-0829
Mailing Address - Fax:
Practice Address - Street 1:15290 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8515
Practice Address - Country:US
Practice Address - Phone:909-256-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1121071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice