Provider Demographics
NPI:1316781958
Name:ROSANDER, COLIN (DMD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:ROSANDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14804 E 77TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 S OSAGE AVE
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:OK
Practice Address - Zip Code:74029-2742
Practice Address - Country:US
Practice Address - Phone:918-534-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice