Provider Demographics
NPI:1043419278
Name:JEAN, ROSE MADELEINE (RDH)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MADELEINE
Last Name:JEAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3297 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2655
Mailing Address - Country:US
Mailing Address - Phone:617-983-6070
Mailing Address - Fax:617-983-0434
Practice Address - Street 1:3297 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2655
Practice Address - Country:US
Practice Address - Phone:617-983-6070
Practice Address - Fax:617-983-0434
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11436124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist