Provider Demographics
NPI:1194960138
Name:ROSE, CAMILLE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:ROSE
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 1:6646 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1231
Mailing Address - Country:US
Mailing Address - Phone:407-292-6400
Mailing Address - Fax:
Practice Address - Street 1:6646 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1231
Practice Address - Country:US
Practice Address - Phone:407-292-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL200051223X0400X
DC10000201223X0400X
MD123801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics