MEDICARE: DR. ALLISON ROSE DMD

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	1223P0221X	Pediatric Dentistry	DS-031312L	PA

General Provider Information

NPI Number	:	1558355982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON ROSE DMD

Provider Business Mailing Address
First Line	:	1637 OAKWOOD DR
Second Line	:	SOUTH 319
City	:	NARBERTH
State	:	PA
Zip	:	19072-1002
Country	:	US
Telephone Number	:	610-617-0374
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 ISLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-2300
Country	:	US
Telephone Number	:	215-365-1033
Fax Number	:	215-365-1145

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	08/02/2010

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