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General NPI Number Information
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NPI Number | 1326889841
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Entity Type | Organization
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Legal Business Name | MARIN ROSENVOLD DDS PLLC
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 3333 S WADSWORTH BLVD UNIT 303D
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City | LAKEWOOD
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State | CO
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Zip | 80227-5142
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Country | US
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Telephone | 701-367-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 S WADSWORTH BLVD UNIT 303D
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City | LAKEWOOD
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State | CO
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Zip | 80227-5142
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Country | US
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Telephone | 701-367-9333
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MARIN ROSENVOLD
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Credential | DDS
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Telephone | 701-367-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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