Provider Demographics
NPI:1881640480
Name:ROSSI, HENRY DAVID III (DDS)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:DAVID
Last Name:ROSSI
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:617 ETHAN ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOWARDS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53083-1267
Mailing Address - Country:US
Mailing Address - Phone:920-565-3369
Mailing Address - Fax:920-565-3360
Practice Address - Street 1:617 ETHAN ALLEN DR
Practice Address - Street 2:
Practice Address - City:HOWARDS GROVE
Practice Address - State:WI
Practice Address - Zip Code:53083-1267
Practice Address - Country:US
Practice Address - Phone:920-565-3369
Practice Address - Fax:920-565-3360
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4455-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice