Provider Demographics
NPI:1013947936
Name:ROZEN, STEPHEN SLATER (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SLATER
Last Name:ROZEN
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 1:546 S. BROAD ST.
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450
Mailing Address - Country:US
Mailing Address - Phone:203-639-0800
Mailing Address - Fax:203-639-0324
Practice Address - Street 1:546 S. BROAD ST.
Practice Address - Street 2:SUITE 2A
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450
Practice Address - Country:US
Practice Address - Phone:203-639-0800
Practice Address - Fax:203-639-0324
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3716204E00000X
CT0037161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery