Provider Demographics
NPI:1023030434
Name:ROSSOW, MARC ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
Last Name:ROSSOW
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 1:2971 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2832
Mailing Address - Country:US
Mailing Address - Phone:585-266-2300
Mailing Address - Fax:585-266-2312
Practice Address - Street 1:2971 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2832
Practice Address - Country:US
Practice Address - Phone:585-266-2300
Practice Address - Fax:585-266-2312
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0465591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice