Provider Demographics
NPI:1124405238
Name:MAGNO, ROSE (DDS)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:MAGNO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 SHELLMOUND ST STE 125
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1924
Mailing Address - Country:US
Mailing Address - Phone:510-595-1600
Mailing Address - Fax:
Practice Address - Street 1:6001 SHELLMOUND ST STE 125
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1924
Practice Address - Country:US
Practice Address - Phone:510-595-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist