Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4929 | VA |
NPI | 1194720029 |
---|---|
Provider Name | Dr. John B. Rose III |
First Address | Fredericksburg, VA 22405-2561 |
Second Address | Fredericksburg, VA 22405-2561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 13/09/2007 |