Healthcare Provider Details

I. General information

NPI: 1427238799
Provider Name (Legal Business Name): STEVE PAUL ROSE D.D.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARPENTER RD
FT MYER VA
22211-1009
US

IV. Provider business mailing address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-3460
  • Fax: 703-696-0586
Mailing address:
  • Phone: 703-696-3460
  • Fax: 703-696-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN - 9467
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: