MEDICARE: MISS ROSSEL L DIOSO RDH

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	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1538369913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ROSSEL L DIOSO RDH

Provider Business Mailing Address
First Line	:	5712 TRELLIS ARCH
Second Line	:	#104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1552
Country	:	US
Telephone Number	:	757-961-9420
Fax Number	:

Provider Business Practice Location Address
First Line	:	5712 TRELLIS ARCH
Second Line	:	#104
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1552
Country	:	US
Telephone Number	:	757-961-9420
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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