Provider Demographics
NPI:1073767836
Name:ROSA, HARVEY S (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:S
Last Name:ROSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20475 BISCAYNE BLVD
Mailing Address - Street 2:SUITE G-9
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1550
Mailing Address - Country:US
Mailing Address - Phone:305-935-4030
Mailing Address - Fax:305-935-4448
Practice Address - Street 1:20475 BISCAYNE BLVD
Practice Address - Street 2:SUITE G-9
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1550
Practice Address - Country:US
Practice Address - Phone:305-935-4030
Practice Address - Fax:305-935-4448
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice