MEDICARE: DR. MICHAEL STEPHEN ROSE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5765	NV

General Provider Information

NPI Number	:	1043461312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL STEPHEN ROSE DDS

Provider Business Mailing Address
First Line	:	4230 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2397
Country	:	US
Telephone Number	:	702-459-8998
Fax Number	:	702-459-8078

Provider Business Practice Location Address
First Line	:	4230 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2397
Country	:	US
Telephone Number	:	702-459-8998
Fax Number	:	702-459-8078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	10/06/2008

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