Provider Demographics
NPI:1649856261
Name:ROSEBOROUGH, ALYSSA F
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:F
Last Name:ROSEBOROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 N CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2206
Mailing Address - Country:US
Mailing Address - Phone:480-766-6853
Mailing Address - Fax:
Practice Address - Street 1:2730 S VAL VISTA DR STE 164
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1680
Practice Address - Country:US
Practice Address - Phone:480-633-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH009481124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist