Provider Demographics
NPI:1992881130
Name:ROSE DUNCAN, MARY E (DDS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:ROSE DUNCAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 STONEWALL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401
Mailing Address - Country:US
Mailing Address - Phone:903-454-4636
Mailing Address - Fax:903-450-0181
Practice Address - Street 1:4613 STONEWALL ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:903-454-4636
Practice Address - Fax:903-450-0181
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice