Provider Demographics
NPI:1871633487
Name:ROSEN, HERBERT CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:CHARLES
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 1:111 ELM ST
Mailing Address - Street 2:201
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1967
Mailing Address - Country:US
Mailing Address - Phone:508-757-2190
Mailing Address - Fax:508-797-0523
Practice Address - Street 1:111 ELM ST
Practice Address - Street 2:201
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1967
Practice Address - Country:US
Practice Address - Phone:508-757-2190
Practice Address - Fax:508-797-0523
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics