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General NPI Number Information
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NPI Number | 1144042706
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Entity Type | Individual
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Provider Name | JEFFREY ROSETH
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Gender | Male
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 1000 YGNACIO VALLEY RD
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City | WALNUT CREEK
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State | CA
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Zip | 94598-1812
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Country | US
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Telephone | 559-708-2077
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Fax |
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Provider Business Mailing Address
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Address Line | 965 HYDE ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-4837
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Country | US
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Telephone | 559-708-2077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 110852
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License Number State | CA
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