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General NPI Number Information
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NPI Number | 1376383307
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Entity Type | Individual
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Provider Name | SAMANTHA MICHELLE ROSE DDS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 191 MAIN ST
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City | SPRINGFIELD
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State | NE
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Zip | 68059-2530
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Country | US
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Telephone | 402-253-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 4431 S 57TH ST
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City | LINCOLN
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State | NE
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Zip | 68516-1402
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Country | US
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Telephone | 402-853-4051
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 8006
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License Number State | NE
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