Healthcare Provider Details

I. General information

NPI: 1932272945
Provider Name (Legal Business Name): ROSEWOOD DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W VINE ST SUITE A
TOOELE UT
84074-2036
US

IV. Provider business mailing address

181 W VINE ST SUITE A
TOOELE UT
84074-2036
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-0099
  • Fax: 435-882-1040
Mailing address:
  • Phone: 435-882-0099
  • Fax: 435-882-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1223G0001X
License Number StateUT

VIII. Authorized Official

Name: DR. MICHAEL STEVEN ROCKWELL
Title or Position: OWNER
Credential: D.D.S.
Phone: 435-882-0099