Provider Demographics
NPI:1285779777
Name:ROSE, FRANK R I (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:R
Last Name:ROSE
Suffix:I
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 1:16935 HIGHWAY 124
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-9639
Mailing Address - Country:US
Mailing Address - Phone:409-794-1487
Mailing Address - Fax:409-794-1491
Practice Address - Street 1:16935 HIGHWAY 124
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-9639
Practice Address - Country:US
Practice Address - Phone:409-794-1487
Practice Address - Fax:409-794-1491
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD123231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice