Provider Demographics
NPI:1386897841
Name:ROSENAU, LANCE
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:ROSENAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 MERCANTILE DR
Mailing Address - Street 2:SUITE 740
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3597
Mailing Address - Country:US
Mailing Address - Phone:503-699-7691
Mailing Address - Fax:503-675-0830
Practice Address - Street 1:4200 MERCANTILE DR
Practice Address - Street 2:SUITE 740
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3597
Practice Address - Country:US
Practice Address - Phone:503-699-7691
Practice Address - Fax:503-675-0830
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD50101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice