Provider Demographics
NPI:1013588615
Name:ROSADO, MARIAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:ROSADO
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 1:16550 HENDERSON PASS APT 1502
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3261
Mailing Address - Country:US
Mailing Address - Phone:936-777-5600
Mailing Address - Fax:
Practice Address - Street 1:4812 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2737
Practice Address - Country:US
Practice Address - Phone:210-977-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice