Provider Demographics
NPI:1457386997
Name:ROSADO, GUILLERMO L (DMD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:L
Last Name:ROSADO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMDT CG-1122 US COAST GUARD
Mailing Address - Street 2:2100 2ND STREET SW, SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:510-437-3615
Mailing Address - Fax:
Practice Address - Street 1:COMDT CG-1122 US COAST GUARD
Practice Address - Street 2:2100 2ND STREET SW, SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:510-437-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist