Provider Demographics
NPI:1386467389
Name:ROSEN, STEVEN EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:ROSEN
Suffix:
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 1:2090 SW 71ST TER STE G9
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7322
Mailing Address - Country:US
Mailing Address - Phone:954-309-4845
Mailing Address - Fax:
Practice Address - Street 1:2090 SW 71ST TER STE G9
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7322
Practice Address - Country:US
Practice Address - Phone:954-309-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN75911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice