Healthcare Provider Details

I. General information

NPI: 1275586661
Provider Name (Legal Business Name): ROSANNE SCIGLIANO EGGLESTON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6883 CASCADE RD SE
GRAND RAPIDS MI
49546-6899
US

IV. Provider business mailing address

6883 CASCADE RD SE
GRAND RAPIDS MI
49546-6899
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-0730
  • Fax:
Mailing address:
  • Phone: 616-949-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901015835
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: