Provider Demographics
NPI:1003411224
Name:ROSA, DENYS JOSE (RHD)
Entity Type:Individual
Prefix:
First Name:DENYS
Middle Name:JOSE
Last Name:ROSA
Suffix:
Gender:M
Credentials:RHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 PURITAN CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-8352
Mailing Address - Country:US
Mailing Address - Phone:813-409-0552
Mailing Address - Fax:
Practice Address - Street 1:7340 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2222
Practice Address - Country:US
Practice Address - Phone:813-886-1800
Practice Address - Fax:813-886-0519
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH27941124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist