Provider Demographics
NPI:1134553449
Name:ROSEN, PAUL S (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5515
Mailing Address - Country:US
Mailing Address - Phone:215-579-0907
Mailing Address - Fax:215-579-5925
Practice Address - Street 1:907 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5515
Practice Address - Country:US
Practice Address - Phone:215-579-0907
Practice Address - Fax:215-579-5925
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0146901223P0300X
NJ22DI016439001223P0300X
NY0416901223P0300X
PADS026156-L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics