Provider Demographics
NPI:1942389259
Name:ROSE, JOHN M (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:ROSE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
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Mailing Address - Street 1:316 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970
Mailing Address - Country:US
Mailing Address - Phone:815-432-4924
Mailing Address - Fax:815-432-5291
Practice Address - Street 1:316 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970
Practice Address - Country:US
Practice Address - Phone:815-432-4924
Practice Address - Fax:815-432-5291
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics