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General NPI Number Information
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NPI Number | 1679790828
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Entity Type | Organization
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Legal Business Name | JACQUELINE G ROSEN
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 1866 SHERIDAN RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2547
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Country | US
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Telephone | 847-432-1614
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Fax |
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Provider Business Mailing Address
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Address Line | 1866 SHERIDAN RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2547
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Country | US
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Telephone | 847-432-1614
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUELINE G ROSEN
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Credential | D.D.S., M.S.,PC
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Telephone | 847-432-1614
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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 | 021-001225
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License Number State | IL
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