Provider Demographics
NPI:1578027850
Name:FINE DENTAL CARE MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:FINE DENTAL CARE MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-643-0774
Mailing Address - Street 1:955 DAIRY ASHFORD RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5307
Mailing Address - Country:US
Mailing Address - Phone:281-809-3595
Mailing Address - Fax:
Practice Address - Street 1:955 DAIRY ASHFORD RD STE 107
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5307
Practice Address - Country:US
Practice Address - Phone:281-809-3595
Practice Address - Fax:281-809-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty