Provider Demographics
NPI:1356081228
Name:ROZACH DENTAL, LLC
Entity type:Organization
Organization Name:ROZACH DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:WEBSTER
Authorized Official - Last Name:QUARTANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-327-6501
Mailing Address - Street 1:6061 PINNACLE PKWY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9193
Mailing Address - Country:US
Mailing Address - Phone:985-327-6501
Mailing Address - Fax:985-327-6506
Practice Address - Street 1:6061 PINNACLE PKWY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9193
Practice Address - Country:US
Practice Address - Phone:985-327-6501
Practice Address - Fax:985-327-6506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROZACH DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty