Provider Demographics
NPI:1699873703
Name:ROSENGREN, PHILIP NELS (DDS)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:NELS
Last Name:ROSENGREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7849 RUSSLING LEAF DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8292
Mailing Address - Country:US
Mailing Address - Phone:702-243-2347
Mailing Address - Fax:
Practice Address - Street 1:7901 W TROPICAL PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4549
Practice Address - Country:US
Practice Address - Phone:702-839-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice