Provider Demographics
NPI:1093830846
Name:ROSE, KARL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:A
Last Name:ROSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9427 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2082
Mailing Address - Country:US
Mailing Address - Phone:301-983-2562
Mailing Address - Fax:301-652-5609
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 620
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-652-3355
Practice Address - Fax:301-652-5609
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD541271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics