Healthcare Provider Details

I. General information

NPI: 1356682124
Provider Name (Legal Business Name): JILLIAN ROZANSKI DDS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 SPARKS BLVD
SPARKS NV
89434
US

IV. Provider business mailing address

735 SPARKS BLVD
SPARKS NV
89434-7930
US

V. Phone/Fax

Practice location:
  • Phone: 775-237-2038
  • Fax:
Mailing address:
  • Phone: 775-237-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number31463
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberS2-190C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: