MEDICARE: GABRIELA ROSAS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	28101	TX

General Provider Information

NPI Number	:	1427305424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA ROSAS DMD

Provider Business Mailing Address
First Line	:	1743 WESTMEADOW TRL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1238
Country	:	US
Telephone Number	:	201-707-1674
Fax Number	:

Provider Business Practice Location Address
First Line	:	10009 N LAMAR BLVD STE C
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-4117
Country	:	US
Telephone Number	:	512-491-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2012
Last Update Date	:	08/08/2012

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