Healthcare Provider Details

I. General information

NPI: 1497022461
Provider Name (Legal Business Name): GRANT D. ROSEN, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ROMIE LN STE B
SALINAS CA
93901-4210
US

IV. Provider business mailing address

750 E ROMIE LN STE B
SALINAS CA
93901-4210
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-0881
  • Fax:
Mailing address:
  • Phone: 831-424-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number25834
License Number StateCA

VIII. Authorized Official

Name: DR. GRANT ROSEN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 831-424-0881