=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588139026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSEMAN UNIVERSITY OF HEALTH SCIENCES, A NEVADA NON-PROFIT CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2018
-----------------------------------------------------
Last Update Date | 05/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 SUNSET WAY STE B
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89014-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-990-4433
-----------------------------------------------------
Fax | 702-968-5577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 SUNSET WAY
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89014-2333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-990-4433
-----------------------------------------------------
Fax | 702-968-5577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEAN
-----------------------------------------------------
Name | DR. FRANK LICARI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 801-878-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------