Provider Demographics
NPI:1770847642
Name:DAMERON, ROSEANN MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSEANN
Middle Name:MARIE
Last Name:DAMERON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ROSEANN
Other - Middle Name:MARIE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1140 PICKERING DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5762
Mailing Address - Country:US
Mailing Address - Phone:918-706-3640
Mailing Address - Fax:918-619-6180
Practice Address - Street 1:1717 WEST COWLES STREET
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4803
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3837
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63841223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health