Provider Demographics
NPI:1114970241
Name:ROSATO, RICHARD J (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:ROSATO
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 1:6 LOUDON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5321
Mailing Address - Country:US
Mailing Address - Phone:603-225-0008
Mailing Address - Fax:603-225-8120
Practice Address - Street 1:6 LOUDON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5321
Practice Address - Country:US
Practice Address - Phone:603-225-0008
Practice Address - Fax:603-225-8120
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1053OtherNORTHEAST DELTA DENTAL
NH02Y002478NH02OtherBLUECROSS BLUESHIELD
NH30314308Medicaid
NH1393OtherCIGNA
NH02Y002478NH02OtherBLUECROSS BLUESHIELD
NH1053OtherNORTHEAST DELTA DENTAL