Provider Demographics
NPI:1689888745
Name:ROSETTI, JASON OSER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:OSER
Last Name:ROSETTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 25TH AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-1932
Mailing Address - Country:US
Mailing Address - Phone:228-867-0121
Mailing Address - Fax:228-867-0152
Practice Address - Street 1:1301 25TH AVE
Practice Address - Street 2:STE 3
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-1932
Practice Address - Country:US
Practice Address - Phone:228-867-0121
Practice Address - Fax:228-867-0121
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSFR18275081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ39Medicare UPIN