Provider Demographics
NPI:1558355982
Name:ROSE, ALLISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 OAKWOOD DR
Mailing Address - Street 2:SOUTH 319
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1002
Mailing Address - Country:US
Mailing Address - Phone:610-617-0374
Mailing Address - Fax:
Practice Address - Street 1:2821 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2300
Practice Address - Country:US
Practice Address - Phone:215-365-1033
Practice Address - Fax:215-365-1145
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-031312L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry