Provider Demographics
NPI:1043317449
Name:ROSE, KARL DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:DAVID
Last Name:ROSE
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-0157
Mailing Address - Country:US
Mailing Address - Phone:360-687-5665
Mailing Address - Fax:360-687-5053
Practice Address - Street 1:15 SW 20TH AVE.
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604
Practice Address - Country:US
Practice Address - Phone:360-687-5665
Practice Address - Fax:360-687-5053
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA97911223G0001X
WA45391223G0001X
WA71071223G0001X
WA5419124Q00000X
WA5766124Q00000X
WA7057124Q00000X
WA6008124Q00000X
WA2969124Q00000X
WA4236124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered124Q00000XDental ProvidersDental Hygienist