Provider Demographics
NPI:1255421889
Name:ROSZKOWSKI, STACY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNN
Last Name:ROSZKOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LIVINGSTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:W. ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118
Mailing Address - Country:US
Mailing Address - Phone:651-457-4888
Mailing Address - Fax:651-457-6682
Practice Address - Street 1:1525 LIVINGSTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:W. ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118
Practice Address - Country:US
Practice Address - Phone:651-457-4888
Practice Address - Fax:651-457-6682
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist