Provider Demographics
NPI:1245424399
Name:ROSEDALE DENTAL
Entity Type:Organization
Organization Name:ROSEDALE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE MARIE
Authorized Official - Middle Name:BANIQUED
Authorized Official - Last Name:QUIMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-538-4496
Mailing Address - Street 1:2926 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3655
Mailing Address - Country:US
Mailing Address - Phone:310-538-4496
Mailing Address - Fax:310-538-4495
Practice Address - Street 1:2926 MARINE AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3655
Practice Address - Country:US
Practice Address - Phone:310-538-4496
Practice Address - Fax:310-538-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty