Provider Demographics
NPI:1851419634
Name:ROSE, LLOYD W (D D S)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:W
Last Name:ROSE
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BLUECUTT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1470
Mailing Address - Country:US
Mailing Address - Phone:662-328-1600
Mailing Address - Fax:662-328-1607
Practice Address - Street 1:2900 BLUECUTT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1470
Practice Address - Country:US
Practice Address - Phone:662-328-1600
Practice Address - Fax:662-328-1607
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS889-581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice