Provider Demographics
NPI:1376383307
Name:ROSE, SAMANTHA MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:ROSE
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 1:4431 S 57TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1402
Mailing Address - Country:US
Mailing Address - Phone:402-853-4051
Mailing Address - Fax:
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NE
Practice Address - Zip Code:68059-2530
Practice Address - Country:US
Practice Address - Phone:402-253-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist