Provider Demographics
NPI:1053834432
Name:DIDIER, ROSEMARY LEANETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:LEANETTE
Last Name:DIDIER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3171
Mailing Address - Country:US
Mailing Address - Phone:787-718-7277
Mailing Address - Fax:
Practice Address - Street 1:814 E IRVING BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-3148
Practice Address - Country:US
Practice Address - Phone:972-663-5384
Practice Address - Fax:972-663-5284
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice