Provider Demographics
NPI:1154529659
Name:ROSEN, EDWARD L (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
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 1:21500 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1938
Mailing Address - Country:US
Mailing Address - Phone:818-999-6165
Mailing Address - Fax:818-598-2198
Practice Address - Street 1:21500 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1938
Practice Address - Country:US
Practice Address - Phone:818-999-6165
Practice Address - Fax:818-598-2198
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice