Provider Demographics
NPI:1063829877
Name:ROSARIO, JESSE O (DMD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:O
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20102 TWILIGHT CANYON RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6150 METROWEST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3291
Practice Address - Country:US
Practice Address - Phone:407-532-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN207911223E0200X
TX350801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics