Provider Demographics
NPI:1205182193
Name:DIMOV, ROSEN GEORGIEV (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSEN
Middle Name:GEORGIEV
Last Name:DIMOV
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 1:6305 143RD PL SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-5252
Mailing Address - Country:US
Mailing Address - Phone:862-452-0961
Mailing Address - Fax:
Practice Address - Street 1:6607 W CANAL DR
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5077
Practice Address - Country:US
Practice Address - Phone:862-452-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE.60294925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist