Provider Demographics
NPI:1861182073
Name:MARATTIL, ROSANN
Entity type:Individual
Prefix:
First Name:ROSANN
Middle Name:
Last Name:MARATTIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406
Mailing Address - Country:US
Mailing Address - Phone:630-803-8237
Mailing Address - Fax:
Practice Address - Street 1:6218 WASHINGTON AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406
Practice Address - Country:US
Practice Address - Phone:630-803-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001878-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice