Provider Demographics
NPI:1316063969
Name:ROOS, BRYAN K (DMD, MSD, MS, PS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:K
Last Name:ROOS
Suffix:
Gender:M
Credentials:DMD, MSD, MS, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16150 NE 85TH ST STE 124
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3544
Mailing Address - Country:US
Mailing Address - Phone:425-885-1642
Mailing Address - Fax:425-869-8317
Practice Address - Street 1:16150 NE 85TH ST STE 124
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3544
Practice Address - Country:US
Practice Address - Phone:425-885-1642
Practice Address - Fax:425-869-8317
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA95341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics