Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | FL8066 | FL |
NPI | 1003224643 |
---|---|
Provider Name | Dr. Peter A. Rossen |
First Address | Coconut Creek, FL 33063-3944 |
Second Address | Coconut Creek, FL 33063-3944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2014 |
Last Update Date | 28/07/2014 |