Provider Demographics
NPI:1396087375
Name:MARK S ROSEBUSH
Entity type:Organization
Organization Name:MARK S ROSEBUSH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSEBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-656-5200
Mailing Address - Street 1:2376 MAIN ST
Mailing Address - Street 2:STE 812
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4024
Mailing Address - Country:US
Mailing Address - Phone:406-656-5200
Mailing Address - Fax:406-656-5200
Practice Address - Street 1:2376 MAIN ST
Practice Address - Street 2:STE 812
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4024
Practice Address - Country:US
Practice Address - Phone:406-656-5200
Practice Address - Fax:406-656-5200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK S ROSEBUSH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty