Provider Demographics
NPI:1245203793
Name:ROSARIO, LUIS FRANCISCO (DDS)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FRANCISCO
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 12 BLDG 449 ATTN PROFESSIONAL AFFAIRS
Mailing Address - Street 2:NAVAL HEALTH CARE NEW ENGLAND GROTON
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-2377
Mailing Address - Fax:860-694-2590
Practice Address - Street 1:1173 WHIPPLE ROAD
Practice Address - Street 2:BRANCH DENTAL CLINIC NEWPORT
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841
Practice Address - Country:US
Practice Address - Phone:860-694-2377
Practice Address - Fax:860-694-3590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 00129521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN