Provider Demographics
NPI:1396252508
Name:ROSSEY, DOREE LYN (PHDHP)
Entity type:Individual
Prefix:MRS
First Name:DOREE
Middle Name:LYN
Last Name:ROSSEY
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL ARTS BLDG
Mailing Address - Street 2:SUITE 170
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-8894
Mailing Address - Country:US
Mailing Address - Phone:724-548-2283
Mailing Address - Fax:724-543-4380
Practice Address - Street 1:100 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 170
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8894
Practice Address - Country:US
Practice Address - Phone:724-548-2283
Practice Address - Fax:724-543-4380
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH067521124Q00000X
PAPHDH000406124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist