Provider Demographics
NPI:1497022461
Name:GRANT D. ROSEN, D.D.S., INC.
Entity Type:Organization
Organization Name:GRANT D. ROSEN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-424-0881
Mailing Address - Street 1:750 E ROMIE LN STE B
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4210
Mailing Address - Country:US
Mailing Address - Phone:831-424-0881
Mailing Address - Fax:
Practice Address - Street 1:750 E ROMIE LN STE B
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4210
Practice Address - Country:US
Practice Address - Phone:831-424-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25834332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2583401OtherDENTICAL