Provider Demographics
NPI:1568014827
Name:DAVID B ROSEN DMD
Entity type:Organization
Organization Name:DAVID B ROSEN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-862-4550
Mailing Address - Street 1:57 BEDFORD ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4550
Mailing Address - Country:US
Mailing Address - Phone:781-674-9995
Mailing Address - Fax:
Practice Address - Street 1:57 BEDFORD ST STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4550
Practice Address - Country:US
Practice Address - Phone:781-674-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty