Provider Demographics
NPI:1629146634
Name:ROOSMA, DIRK FRED (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:FRED
Last Name:ROOSMA
Suffix:
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:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59845-0127
Mailing Address - Country:US
Mailing Address - Phone:406-741-5031
Mailing Address - Fax:
Practice Address - Street 1:25 LITTLE BITTERROOT RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59845
Practice Address - Country:US
Practice Address - Phone:406-741-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice