Provider Demographics
NPI:1265491534
Name:ROSEN, SEYMOUR L (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:L
Last Name:ROSEN
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 1:1550 E MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1499
Mailing Address - Country:US
Mailing Address - Phone:602-285-9979
Mailing Address - Fax:602-265-5883
Practice Address - Street 1:1550 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1499
Practice Address - Country:US
Practice Address - Phone:602-285-9979
Practice Address - Fax:602-265-5883
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice