Provider Demographics
NPI:1841356052
Name:ROSE, SCOTT LESLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LESLIE
Last Name:ROSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SOM CENTER RD
Mailing Address - Street 2:SUITE B-10
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2944
Mailing Address - Country:US
Mailing Address - Phone:440-542-1200
Mailing Address - Fax:440-542-1202
Practice Address - Street 1:6200 SOM CENTER RD
Practice Address - Street 2:SUITE B-10
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2944
Practice Address - Country:US
Practice Address - Phone:440-542-1200
Practice Address - Fax:440-542-1202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice