MEDICARE: DR. ORLANDO LUIS ROSA D.M.D.

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	2150	PR

General Provider Information

NPI Number	:	1922134550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ORLANDO LUIS ROSA D.M.D.

Provider Business Mailing Address
First Line	:	1452 AVE ASHFORD
Second Line	:	SUITE 1-C
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1581
Country	:	US
Telephone Number	:	787-722-2351
Fax Number	:	787-722-2351

Provider Business Practice Location Address
First Line	:	1452 AVE ASHFORD
Second Line	:	SUITE 1-C
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1581
Country	:	US
Telephone Number	:	787-722-2351
Fax Number	:	787-722-2351

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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