Provider Demographics
NPI:1417698523
Name:ROSEN, KIERA ANNE
Entity type:Individual
Prefix:
First Name:KIERA
Middle Name:ANNE
Last Name:ROSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1316
Mailing Address - Country:US
Mailing Address - Phone:973-900-7508
Mailing Address - Fax:
Practice Address - Street 1:421 ESSEX ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1316
Practice Address - Country:US
Practice Address - Phone:973-900-7508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029507001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice