Provider Demographics
NPI:1083266969
Name:ROZOV, MARIYA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:ROZOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SUSANNA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1340
Mailing Address - Country:US
Mailing Address - Phone:347-261-6731
Mailing Address - Fax:
Practice Address - Street 1:4257 US 9 STE A
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8310
Practice Address - Country:US
Practice Address - Phone:732-639-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist