Provider Demographics
NPI:1215827704
Name:ROSALES, MAGLEN A (CD)
Entity type:Individual
Prefix:MRS
First Name:MAGLEN
Middle Name:A
Last Name:ROSALES
Suffix:
Gender:F
Credentials:CD
Other - Prefix:MRS
Other - First Name:MAGLEN
Other - Middle Name:A
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CIRUJANO DENTISTA
Mailing Address - Street 1:266 N SAN MARCOS ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5029
Mailing Address - Country:US
Mailing Address - Phone:830-513-7370
Mailing Address - Fax:
Practice Address - Street 1:CALLE VERACRUZ #101 COLONIA ROMA, PIEDRAS NEGRAS, COAHU
Practice Address - Street 2:PIEDRAS NEGRAS
Practice Address - City:COAHUILA
Practice Address - State:MEXICO
Practice Address - Zip Code:26025
Practice Address - Country:MX
Practice Address - Phone:878-210-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102751451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice