Provider Demographics
NPI:1891468328
Name:ROSE DENTAL AT LAKEWOOD RANCH, PLLC
Entity Type:Organization
Organization Name:ROSE DENTAL AT LAKEWOOD RANCH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-210-3975
Mailing Address - Street 1:5561 BROADCAST CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8472
Mailing Address - Country:US
Mailing Address - Phone:561-309-6657
Mailing Address - Fax:
Practice Address - Street 1:5561 BROADCAST CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8472
Practice Address - Country:US
Practice Address - Phone:941-210-3975
Practice Address - Fax:941-487-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1972916930OtherNPI