Healthcare Provider Details

I. General information

NPI: 1215827704
Provider Name (Legal Business Name): MAGLEN A ROSALES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAGLEN A ROSALES DENTAL SURGEON

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 N SAN MARCOS ST
EAGLE PASS TX
78852-5029
US

IV. Provider business mailing address

266 N SAN MARCOS ST
EAGLE PASS TX
78852-5029
US

V. Phone/Fax

Practice location:
  • Phone: 830-513-7370
  • Fax:
Mailing address:
  • Phone: 830-513-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10275145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: