Provider Demographics
NPI:1891915633
Name:ROSALES, DAWN M
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:ROSALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PUCKETT TER SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4053
Mailing Address - Country:US
Mailing Address - Phone:770-931-1924
Mailing Address - Fax:678-990-9493
Practice Address - Street 1:609 BEAVER RUIN RD NW STE A
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3401
Practice Address - Country:US
Practice Address - Phone:770-925-3300
Practice Address - Fax:770-925-3302
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant