Provider Demographics
NPI:1407977291
Name:ROSICH, FRANK CARL (DDS)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:CARL
Last Name:ROSICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:CARL
Other - Middle Name:
Other - Last Name:ROSICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:525 S FAIRMONT AVE STE H
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3860
Mailing Address - Country:US
Mailing Address - Phone:209-369-2696
Mailing Address - Fax:
Practice Address - Street 1:525 S FAIRMONT AVE STE H
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3860
Practice Address - Country:US
Practice Address - Phone:209-369-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA212861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice