Provider Demographics
NPI:1083226435
Name:ROSENE, LAUREN EDITH (DD S)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:EDITH
Last Name:ROSENE
Suffix:
Gender:F
Credentials:DD S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GREG KRUSCHEK AVENUE
Mailing Address - Street 2:P.O. BOX 966
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762
Mailing Address - Country:US
Mailing Address - Phone:907-443-3209
Mailing Address - Fax:
Practice Address - Street 1:1000 GREG KRUSCHEK AVENUE
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762
Practice Address - Country:US
Practice Address - Phone:907-443-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice