Provider Demographics
NPI:1275622334
Name:ROSE, PATRICIA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:ROSE
Suffix:
Gender:F
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:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:KIMBERTON
Mailing Address - State:PA
Mailing Address - Zip Code:19442-0507
Mailing Address - Country:US
Mailing Address - Phone:610-935-3828
Mailing Address - Fax:
Practice Address - Street 1:10111 VALLEY FORGE CIR
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1111
Practice Address - Country:US
Practice Address - Phone:610-337-2070
Practice Address - Fax:610-337-9895
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-26412-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice