MEDICARE: PHILIP NELS ROSENGREN 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	4865	NV

General Provider Information

NPI Number	:	1699873703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP NELS ROSENGREN DDS

Provider Business Mailing Address
First Line	:	7849 RUSSLING LEAF DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8292
Country	:	US
Telephone Number	:	702-243-2347
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 W TROPICAL PKWY
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4549
Country	:	US
Telephone Number	:	702-839-5030
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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