Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30010305 | OH |
NPI | 1043344880 |
---|---|
Provider Name | Dr. M William Rose |
First Address | Shaker Heights, OH 44122-2517 |
Second Address | Shaker Heights, OH 44122-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |