Healthcare Provider Details

I. General information

NPI: 1114970241
Provider Name (Legal Business Name): RICHARD J. ROSATO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

6 LOUDON RD SUITE 204
CONCORD NH
03301-5321
US

IV. Provider business mailing address

6 LOUDON RD SUITE 204
CONCORD NH
03301-5321
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-0008
  • Fax: 603-225-8120
Mailing address:
  • Phone: 603-225-0008
  • Fax: 603-225-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3188
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: