MEDICARE: DR. ALEXANDER ROSSITCH 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	5569	NC

General Provider Information

NPI Number	:	1073739991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER ROSSITCH DDS

Provider Business Mailing Address
First Line	:	1901 BRUNSWICK AVE
Second Line	:	SUITE 250
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-2809
Country	:	US
Telephone Number	:	704-372-0290
Fax Number	:	704-372-7786

Provider Business Practice Location Address
First Line	:	1901 BRUNSWICK AVE
Second Line	:	SUITE 250
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-2809
Country	:	US
Telephone Number	:	704-372-0290
Fax Number	:	704-372-7786

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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