Provider Demographics
NPI:1124363643
Name:ROSSANNE M. SOSA, DDS, INC
Entity Type:Organization
Organization Name:ROSSANNE M. SOSA, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSSANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-496-9018
Mailing Address - Street 1:7830 CLAIREMONT MESA BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1632
Mailing Address - Country:US
Mailing Address - Phone:858-496-9018
Mailing Address - Fax:858-496-9034
Practice Address - Street 1:7830 CLAIREMONT MESA BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:858-496-9018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51418261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental