Healthcare Provider Details

I. General information

NPI: 1508313560
Provider Name (Legal Business Name): ZUZANNA ROSSA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 NW KINGS BLVD
CORVALLIS OR
97330-1905
US

IV. Provider business mailing address

1731 NW KINGS BLVD
CORVALLIS OR
97330-1905
US

V. Phone/Fax

Practice location:
  • Phone: 541-705-2470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD12303
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: