Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN012652 | GA |
NPI | 1073729422 |
---|---|
Provider Name | Scott Patrick Rose |
First Address | Woodstock, GA 30188-3897 |
Second Address | Marietta, GA 30060-1155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 20/05/2011 |