Provider Demographics
NPI:1871689935
Name:ROSE, DANIEL LEE (MS, DDS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:ROSE
Suffix:
Gender:M
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 BLACKHAWK PLAZA CIR STE 250
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4648
Mailing Address - Country:US
Mailing Address - Phone:925-648-3650
Mailing Address - Fax:925-648-3654
Practice Address - Street 1:4125 BLACKHAWK PLAZA CIR STE 250
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4648
Practice Address - Country:US
Practice Address - Phone:925-648-3650
Practice Address - Fax:925-648-3654
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics