Provider Demographics
NPI:1710069547
Name:ROSAS, REINALDO (DMD, MS)
Entity Type:Individual
Prefix:
First Name:REINALDO
Middle Name:
Last Name:ROSAS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AVE. SAN PATRICIO
Mailing Address - Street 2:EDIF. MARAMAR PLAZA STE. 830
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-781-2737
Mailing Address - Fax:787-783-7320
Practice Address - Street 1:101 AVE. SAN PATRICIO
Practice Address - Street 2:EDIF. MARAMAR PLAZA STE. 830
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-781-2737
Practice Address - Fax:787-783-7320
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5631122300000X
PR25771223P0300X
FLDN172761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist