Provider Demographics
NPI:1154679454
Name:ROSEN, WENDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:ROSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 VALERIE CT
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3416
Mailing Address - Country:US
Mailing Address - Phone:516-456-2373
Mailing Address - Fax:
Practice Address - Street 1:292 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3202
Practice Address - Country:US
Practice Address - Phone:516-887-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist