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General NPI Number Information
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NPI Number | 1922043348
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Entity Type | Organization
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Legal Business Name | ROSA DENTAL CLINIC, PA
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 603 HOSPITAL DR SUITE #2
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2914
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Country | US
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Telephone | 870-425-5955
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Fax | 870-425-5955
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Provider Business Mailing Address
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Address Line | 603 HOSPITAL DR SUITE #2
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2914
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Country | US
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Telephone | 870-425-5955
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Fax | 870-425-5955
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DON K. ROSA
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Credential | D.D.S.
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Telephone | 870-425-5955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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