Provider Demographics
NPI:1861600124
Name:SHRESTHA, ROSI (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSI
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24231 CRENSHAW BLVD
Mailing Address - Street 2:E
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5344
Mailing Address - Country:US
Mailing Address - Phone:310-326-3657
Mailing Address - Fax:310-326-4299
Practice Address - Street 1:24231 CRENSHAW BLVD
Practice Address - Street 2:E
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5344
Practice Address - Country:US
Practice Address - Phone:310-326-3657
Practice Address - Fax:310-326-4299
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17122300000X, 1223G0001X
CA581461223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice