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General NPI Number Information
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NPI Number | 1831427335
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Entity Type | Organization
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Legal Business Name | JOHN M. ROSE, D.D.S., M.S.
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 376 LARRY POWER RD
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5184
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Country | US
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Telephone | 815-802-1217
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Fax | 815-802-1252
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Provider Business Mailing Address
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Address Line | 376 LARRY POWER RD
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5184
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Country | US
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Telephone | 815-802-1217
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Fax | 815-802-1252
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. JOHN M. ROSE
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Credential | D.D.S., M.S.
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Telephone | 815-802-1217
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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 |
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License Number State | IL
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