Provider Demographics
NPI:1174641369
Name:ROSELIN, SADINA
Entity Type:Individual
Prefix:
First Name:SADINA
Middle Name:
Last Name:ROSELIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E LONG LAKE
Mailing Address - Street 2:STE 311
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-203-1119
Mailing Address - Fax:248-203-1112
Practice Address - Street 1:2141 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRSHAM
Practice Address - State:MA
Practice Address - Zip Code:01095
Practice Address - Country:US
Practice Address - Phone:413-599-1600
Practice Address - Fax:413-599-0913
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist