Provider Demographics
NPI:1669528832
Name:ROSEN, ANDREW M (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:ROSEN
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 1:1245 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1210
Mailing Address - Country:US
Mailing Address - Phone:610-565-5077
Mailing Address - Fax:610-566-1291
Practice Address - Street 1:1245 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1210
Practice Address - Country:US
Practice Address - Phone:610-565-5077
Practice Address - Fax:610-566-1291
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023463-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice