Provider Demographics
NPI:1376678425
Name:HERLIHY, ROSEMARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:HERLIHY
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 1:5804 RIVERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2506
Mailing Address - Country:US
Mailing Address - Phone:239-481-0644
Mailing Address - Fax:
Practice Address - Street 1:7050 WINKLER RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7048
Practice Address - Country:US
Practice Address - Phone:239-489-2626
Practice Address - Fax:239-489-0901
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist