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General NPI Number Information
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NPI Number | 1942389259
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Entity Type | Individual
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Provider Name | JOHN M ROSE DDS MS
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 316 E LINCOLN AVE
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City | WATSEKA
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State | IL
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Zip | 60970
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Country | US
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Telephone | 815-432-4924
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Fax | 815-432-5291
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Provider Business Mailing Address
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Address Line | 316 E LINCOLN AVE
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City | WATSEKA
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State | IL
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Zip | 60970
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Country | US
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Telephone | 815-432-4924
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Fax | 815-432-5291
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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 |
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License Number State | IL
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