Provider Demographics
NPI:1992728745
Name:ROSADO, JAZMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:JAZMIN
Middle Name:
Last Name:ROSADO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 5083
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9731
Mailing Address - Country:US
Mailing Address - Phone:787-279-9750
Mailing Address - Fax:787-279-9769
Practice Address - Street 1:B4 CALLE MARGINAL
Practice Address - Street 2:FLAMINGO TERRACE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-4342
Practice Address - Country:US
Practice Address - Phone:787-279-9750
Practice Address - Fax:787-279-9769
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice