Provider Demographics
NPI:1235227497
Name:ROSELLA, LAUREN SUZANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:SUZANNE
Last Name:ROSELLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:SUZANNE
Other - Last Name:WATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 PARK STREET
Mailing Address - Street 2:DOTY DENTAL
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
Mailing Address - Country:US
Mailing Address - Phone:585-243-6569
Mailing Address - Fax:
Practice Address - Street 1:3 PARK STREET
Practice Address - Street 2:DOTY DENTAL
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-243-6569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY917848OtherDORAL
NY000408997001OtherBC/BS
NY01034940Medicaid
NY135759OtherGUARDIAN
NY4012996OtherINDEPENDENT HEALTH