Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 30026123 | OH |
NPI | 1003439563 |
---|---|
Provider Name | Dr. Lance A Rose |
First Address | New Carlisle, OH 45344-1903 |
Second Address | New Carlisle, OH 45344-1903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2020 |
Last Update Date | 19/09/2021 |