Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 003716 | CT |
N | 204E00000X | Oral & Maxillofacial Surgeon | 3716 | CT |
NPI | 1013947936 |
---|---|
Provider Name | Stephen Slater Rozen |
First Address | Meriden, CT 06450 |
Second Address | Meriden, CT 06450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 20/12/2013 |