Provider Demographics
NPI:1518077809
Name:ROSEMAN, DANIEL B (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:ROSEMAN
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1506
Mailing Address - Country:US
Mailing Address - Phone:617-666-1810
Mailing Address - Fax:617-666-5073
Practice Address - Street 1:174 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1506
Practice Address - Country:US
Practice Address - Phone:617-666-1810
Practice Address - Fax:617-666-5073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice