Provider Demographics
NPI:1962410852
Name:BROSE, KARL MEREDITH (DDS)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:MEREDITH
Last Name:BROSE
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 1:550 WATER ST
Mailing Address - Street 2:STE E-1
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-423-9311
Mailing Address - Fax:831-423-9060
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:STE E-1
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-423-9311
Practice Address - Fax:831-423-9060
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice