Provider Demographics
NPI:1457496986
Name:ROSEN, LAWRENCE A (DDS)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:A
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 1:2121 MAIN STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2670
Mailing Address - Country:US
Mailing Address - Phone:716-835-1933
Mailing Address - Fax:716-835-1937
Practice Address - Street 1:2121 MAIN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2670
Practice Address - Country:US
Practice Address - Phone:716-835-1933
Practice Address - Fax:716-835-1937
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00600880Medicaid