Provider Demographics
NPI:1265881932
Name:NOAH H ROSEN DMD, LLC
Entity type:Organization
Organization Name:NOAH H ROSEN DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-248-6140
Mailing Address - Street 1:2800 N SHERIDAN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6108
Mailing Address - Country:US
Mailing Address - Phone:773-248-6140
Mailing Address - Fax:773-248-4628
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6108
Practice Address - Country:US
Practice Address - Phone:773-248-6140
Practice Address - Fax:773-248-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0297331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty