Provider Demographics
NPI:1609518638
Name:PREMIER, ROSE (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:PREMIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:PREMIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2907
Mailing Address - Country:US
Mailing Address - Phone:617-792-1430
Mailing Address - Fax:
Practice Address - Street 1:32 CRESTON AVE
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2616
Practice Address - Country:US
Practice Address - Phone:617-792-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18594031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice