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General NPI Number Information
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NPI Number | 1730282054
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Entity Type | Organization
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Legal Business Name | GORDON B ROSENGREN, DDS, INC, PS
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24722 104TH AVE SE SUITE 201
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City | KENT
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State | WA
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Zip | 98030-5322
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Country | US
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Telephone | 253-859-0123
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Fax | 253-859-5864
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Provider Business Mailing Address
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Address Line | 24722 104TH AVE SE SUITE 201
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City | KENT
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State | WA
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Zip | 98030-5322
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Country | US
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Telephone | 253-859-0123
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Fax | 253-859-5864
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON B. ROSENGREN
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Credential | DDS
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Telephone | 253-859-0123
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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 | DE00004446
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License Number State | WA
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