Healthcare Provider Details

I. General information

NPI: 1114838901
Provider Name (Legal Business Name): DENNIS ARTHUR ROSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 N 53RD AVE STE 150
PHOENIX AZ
85031-3037
US

IV. Provider business mailing address

3802 N 53RD AVE STE 150
PHOENIX AZ
85031-3037
US

V. Phone/Fax

Practice location:
  • Phone: 623-278-4354
  • Fax:
Mailing address:
  • Phone: 623-278-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-530878
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: