Provider Demographics
NPI:1720103898
Name:FAY, ROSE-MARIE (D,D,S)
Entity type:Individual
Prefix:
First Name:ROSE-MARIE
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:D,D,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 SWEETWATER BLVD
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3136
Mailing Address - Country:US
Mailing Address - Phone:281-313-5888
Mailing Address - Fax:281-313-5898
Practice Address - Street 1:4645 SWEETWATER BLVD
Practice Address - Street 2:SUITE # 300
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3136
Practice Address - Country:US
Practice Address - Phone:281-313-5888
Practice Address - Fax:281-313-5898
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice