Provider Demographics
NPI:1336269414
Name:ROSDICK, JULIAN THOMAS III (DMD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:THOMAS
Last Name:ROSDICK
Suffix:III
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 1:2045 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-871-3523
Mailing Address - Fax:205-871-3551
Practice Address - Street 1:2045 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-871-3523
Practice Address - Fax:205-871-3551
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
24216Medicare UPIN