Healthcare Provider Details

I. General information

NPI: 1487576690
Provider Name (Legal Business Name): BRENTON LEE ROSA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 PARAMOUNT DR STE A
HUNTSVILLE AL
35806-3010
US

IV. Provider business mailing address

1410 PARAMOUNT DR STE A
HUNTSVILLE AL
35806-3010
US

V. Phone/Fax

Practice location:
  • Phone: 256-913-4242
  • Fax:
Mailing address:
  • Phone: 256-913-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD.007696-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: