Provider Demographics
NPI:1598704389
Name:ROSKOS, JOHN M JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:ROSKOS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 S MCCLINTOCK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5006
Mailing Address - Country:US
Mailing Address - Phone:480-838-3233
Mailing Address - Fax:480-838-4775
Practice Address - Street 1:7350 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5006
Practice Address - Country:US
Practice Address - Phone:480-838-3233
Practice Address - Fax:480-838-4775
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4816OtherDENTAL LICENSING BOARD
DCBR4643412OtherUS DEPT OF JUSTICE