Healthcare Provider Details

I. General information

NPI: 1346090065
Provider Name (Legal Business Name): CRYSTAL COAST COSMETIC CARE ENT SURGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 WB MCLEAN DR
CAPE CARTERET NC
28584-8515
US

IV. Provider business mailing address

101 HOPE TOWN CT
CEDAR POINT NC
28584-4501
US

V. Phone/Fax

Practice location:
  • Phone: 252-764-5414
  • Fax:
Mailing address:
  • Phone: 252-503-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID CHRISTOPHER ROSKA
Title or Position: PLLC BUSINESS OWNER
Credential: DO
Phone: 252-503-8707