Healthcare Provider Details

I. General information

NPI: 1598439499
Provider Name (Legal Business Name): ROSE HALEY LINE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE GARDEN DENTISTS, LLC 3426 COLISEUM STREET
NEW ORLEANS LA
70115
US

IV. Provider business mailing address

3426 COLISEUM STREET
NEW ORLEANS LA
70115
US

V. Phone/Fax

Practice location:
  • Phone: 504-895-6657
  • Fax: 504-899-0017
Mailing address:
  • Phone: 504-895-6657
  • Fax: 504-899-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number00205355
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7645
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011129
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: