Healthcare Provider Details

I. General information

NPI: 1760834238
Provider Name (Legal Business Name): ADAM LEE ROSE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 59TH ST W
BRADENTON FL
34209-4607
US

IV. Provider business mailing address

303 MAIN ST APT. 317
HEMPSTEAD NY
11550-1427
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-0088
  • Fax:
Mailing address:
  • Phone: 724-407-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN22807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: