Provider Demographics
NPI:1073729422
Name:ROSE, SCOTT PATRICK (MD, DMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:PATRICK
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 PARKWAY 575
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3897
Mailing Address - Country:US
Mailing Address - Phone:770-924-4095
Mailing Address - Fax:770-924-4096
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 140
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-422-7630
Practice Address - Fax:770-422-6017
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery