Provider Demographics
NPI:1194743104
Name:ROSEN, DEBRA E (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:E
Last Name:ROSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BUSTLETON PIKE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6448
Mailing Address - Country:US
Mailing Address - Phone:215-364-2077
Mailing Address - Fax:215-364-9036
Practice Address - Street 1:217 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6448
Practice Address - Country:US
Practice Address - Phone:215-364-2077
Practice Address - Fax:215-364-9036
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023694L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice