Provider Demographics
NPI:1588945216
Name:ROSE HILL DENTAL PLLC
Entity type:Organization
Organization Name:ROSE HILL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-764-3062
Mailing Address - Street 1:1575 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1457
Mailing Address - Country:US
Mailing Address - Phone:516-764-3062
Mailing Address - Fax:516-764-0266
Practice Address - Street 1:1575 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557
Practice Address - Country:US
Practice Address - Phone:516-764-3062
Practice Address - Fax:516-764-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043726261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental