Provider Demographics
NPI:1093944274
Name:ROSEN, DAVID IAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IAN
Last Name:ROSEN
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 1:4700 SW ARCHER RD
Mailing Address - Street 2:APT S-129
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3883
Mailing Address - Country:US
Mailing Address - Phone:352-682-5480
Mailing Address - Fax:
Practice Address - Street 1:4700 SW ARCHER ROAD
Practice Address - Street 2:APT S 129
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:352-682-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry