Provider Demographics
NPI:1376639369
Name:DAM, ROSEMARIE MYTIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:MYTIEN
Last Name:DAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 E HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5833
Mailing Address - Country:US
Mailing Address - Phone:909-865-6585
Mailing Address - Fax:909-620-6651
Practice Address - Street 1:1182 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5833
Practice Address - Country:US
Practice Address - Phone:909-865-6585
Practice Address - Fax:909-620-6651
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice