Provider Demographics
NPI:1124143102
Name:ROSEN, DAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16542 VENTURA BLVD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2005
Mailing Address - Country:US
Mailing Address - Phone:818-907-6736
Mailing Address - Fax:818-907-0522
Practice Address - Street 1:16542 VENTURA BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2005
Practice Address - Country:US
Practice Address - Phone:818-907-6736
Practice Address - Fax:818-907-0522
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice