Provider Demographics
NPI:1710488838
Name:RALPH W. ROSE DDS PLLC
Entity Type:Organization
Organization Name:RALPH W. ROSE DDS PLLC
Other - Org Name:HOLLYWOOD DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-632-4477
Mailing Address - Street 1:1703 TULANE DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5607
Mailing Address - Country:US
Mailing Address - Phone:936-632-4477
Mailing Address - Fax:936-639-5906
Practice Address - Street 1:1703 TULANE DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5607
Practice Address - Country:US
Practice Address - Phone:936-632-4477
Practice Address - Fax:936-639-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental