Provider Demographics
NPI:1932272945
Name:ROSEWOOD DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ROSEWOOD DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-882-0099
Mailing Address - Street 1:181 W VINE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2036
Mailing Address - Country:US
Mailing Address - Phone:435-882-0099
Mailing Address - Fax:435-882-1040
Practice Address - Street 1:181 W VINE ST
Practice Address - Street 2:SUITE A
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2036
Practice Address - Country:US
Practice Address - Phone:435-882-0099
Practice Address - Fax:435-882-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty