Healthcare Provider Details

I. General information

NPI: 1407663131
Provider Name (Legal Business Name): ROSEOMS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11502 TAYLOR BEECH LN
HOUSTON TX
77071-4101
US

IV. Provider business mailing address

11502 TAYLOR BEECH LN
HOUSTON TX
77071-4101
US

V. Phone/Fax

Practice location:
  • Phone: 908-436-7063
  • Fax:
Mailing address:
  • Phone: 908-436-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN ROSENSTEIN
Title or Position: MANAGER
Credential: DDS
Phone: 908-436-7063