Healthcare Provider Details

I. General information

NPI: 1851407779
Provider Name (Legal Business Name): LARRY A ROSE DDS MS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DAIRY ASHFORD #107
HOUSTON TX
77079
US

IV. Provider business mailing address

909 DAIRY ASHFORD #107
HOUSTON TX
77079
US

V. Phone/Fax

Practice location:
  • Phone: 281-493-2370
  • Fax: 713-729-5253
Mailing address:
  • Phone: 281-493-2370
  • Fax: 713-729-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9115
License Number StateTX

VIII. Authorized Official

Name: DR. LARRY A ROSE
Title or Position: OWNER
Credential: DDS MS
Phone: 281-493-2370