Provider Demographics
NPI:1740304674
Name:ROSALES, VERONICA (DDS)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:
Last Name:ROSALES
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 1:25922 SHERIFF RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-6113
Mailing Address - Country:US
Mailing Address - Phone:714-541-5129
Mailing Address - Fax:
Practice Address - Street 1:1417 N BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3303
Practice Address - Country:US
Practice Address - Phone:714-541-5129
Practice Address - Fax:714-835-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39472OtherMEDI-CAL
CAB39472OtherMEDI-CAL