Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH27941 | FL |
NPI | 1003411224 |
---|---|
Provider Name | Denys Jose Rosa |
First Address | Tampa, FL 33617-8352 |
Second Address | Tampa, FL 33634-2222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2020 |
Last Update Date | 04/12/2020 |