Healthcare Provider Details

I. General information

NPI: 1235009192
Provider Name (Legal Business Name): ROSE DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 MADISON AVE FL 15
NEW YORK NY
10017-1158
US

IV. Provider business mailing address

424 MADISON AVE FL 15
NEW YORK NY
10017-1158
US

V. Phone/Fax

Practice location:
  • Phone: 212-753-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FRANK DICICCO
Title or Position: PRESIDENT
Credential: DMD
Phone: 212-753-7400