Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6742 | KS |
NPI | 1003806191 |
---|---|
Provider Name | Dr. Tommy Rose |
First Address | Kansas City, KS 66101-2516 |
Second Address | Kansas City, KS 66101-2516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 08/07/2007 |