Provider Demographics
NPI:1346051174
Name:ROSEBUD DENTAL AND WELLNESS
Entity type:Organization
Organization Name:ROSEBUD DENTAL AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:614-428-0822
Mailing Address - Street 1:610 TAYLOR STATION RD STE C
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3585
Mailing Address - Country:US
Mailing Address - Phone:614-428-0822
Mailing Address - Fax:
Practice Address - Street 1:610 TAYLOR STATION RD STE C
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3585
Practice Address - Country:US
Practice Address - Phone:614-428-0822
Practice Address - Fax:614-428-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental