Basic Information
| Provider Information | |||||||||
| NPI: | 1598052540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANSOOR | ||||||||
| FirstName: | ROOHEE-TAJ | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 NORTHCHASE PKWY SE | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300676405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709165352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14346 WARWICK BLVD STE 418 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236023817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578862096 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2011 | ||||||||
| LastUpdateDate: | 06/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 0401413215 | VA | Y | Dental Providers | Dentist | General Practice |
No ID Information.