Provider Demographics
NPI:1811193907
Name:ROSE AND ROSE DDS PA
Entity Type:Organization
Organization Name:ROSE AND ROSE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-745-4560
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:55 IRELAND ROAD
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-0489
Mailing Address - Country:US
Mailing Address - Phone:252-745-4560
Mailing Address - Fax:252-745-4862
Practice Address - Street 1:55 IRELAND ROAD
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515-0489
Practice Address - Country:US
Practice Address - Phone:252-745-4560
Practice Address - Fax:252-745-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74791223G0001X
NC74091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902GGMedicaid
NC7409OtherSTATE LICENSE OF DDS
NC89902JAMedicaid
NC7479OtherSTATE LICENSE OF DDS