Provider Demographics
NPI:1114075751
Name:ROSEMAN, LORI WULF (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:WULF
Last Name:ROSEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:ANNETTE
Other - Last Name:WULF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1185 CAVE SPRINGS ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6529
Mailing Address - Country:US
Mailing Address - Phone:636-757-1800
Mailing Address - Fax:636-757-1811
Practice Address - Street 1:1185 CAVE SPRINGS ESTATE DRIVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6529
Practice Address - Country:US
Practice Address - Phone:636-757-1800
Practice Address - Fax:636-757-1811
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice