Provider Demographics
NPI:1760541692
Name:ROSEN, ELLIOTT RORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:RORY
Last Name:ROSEN
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 1:6990 EL CAMINO REAL
Mailing Address - Street 2:SUITE O
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4112
Mailing Address - Country:US
Mailing Address - Phone:760-438-0175
Mailing Address - Fax:760-438-1129
Practice Address - Street 1:6990 EL CAMINO REAL
Practice Address - Street 2:SUITE O
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4112
Practice Address - Country:US
Practice Address - Phone:760-438-0175
Practice Address - Fax:760-438-1129
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist