Provider Demographics
NPI:1972604049
Name:ROSE, RONALD ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ANDREW
Last Name:ROSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CRUM LYNNE
Mailing Address - State:PA
Mailing Address - Zip Code:19022
Mailing Address - Country:US
Mailing Address - Phone:610-833-5588
Mailing Address - Fax:610-833-1760
Practice Address - Street 1:606 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:CRUM LYNNE
Practice Address - State:PA
Practice Address - Zip Code:19022
Practice Address - Country:US
Practice Address - Phone:610-833-5588
Practice Address - Fax:610-833-1760
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024198L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist