Provider Demographics
NPI:1558607879
Name:EDWARD L. ROSEN, DDS, INC.
Entity Type:Organization
Organization Name:EDWARD L. ROSEN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-999-6165
Mailing Address - Street 1:21500 VENTURA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1939
Mailing Address - Country:US
Mailing Address - Phone:818-999-6165
Mailing Address - Fax:818-598-2198
Practice Address - Street 1:6325 TOPANGA CANYON BLVD STE 518
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2049
Practice Address - Country:US
Practice Address - Phone:818-346-8840
Practice Address - Fax:818-346-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty