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General NPI Number Information
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NPI Number | 1881716033
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Entity Type | Individual
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Provider Name | THOMAS P. ROSE D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17900 BROOKHURST ST. SUITE C
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5161
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Country | US
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Telephone | 714-964-0021
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Fax | 714-965-1431
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Provider Business Mailing Address
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Address Line | 17900 BROOKHURST ST. SUITE C
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5161
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Country | US
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Telephone | 714-964-0021
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Fax | 714-965-1431
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 25620
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License Number State | CA
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