Provider Demographics
NPI:1235295007
Name:ROSEN, SCOTT J (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:ROSEN
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 1:981 2ND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1526
Mailing Address - Country:US
Mailing Address - Phone:215-322-8117
Mailing Address - Fax:215-322-8019
Practice Address - Street 1:981 2ND STREET PIKE
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1526
Practice Address - Country:US
Practice Address - Phone:215-322-8117
Practice Address - Fax:215-322-8019
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 027699L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice