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General NPI Number Information
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NPI Number | 1891080776
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Entity Type | Individual
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Provider Name | CHRISTOPHER GREG ROSENVALL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2011
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Last Update Date | 11/02/2019
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Provider Practice Location Address
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Address Line | 12641 OLD GLENN HWY STE 203
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City | EAGLE RIVER
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State | AK
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Zip | 99577
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Country | US
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Telephone | 907-622-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 12641 OLD GLENN HWY STE 203
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7040
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Country | US
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Telephone | 907-622-5437
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-023455
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 32861
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1484
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEND1484
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License Number State | AK
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