1508131715 NPI number — DENTAL BRIGHT

Table of content: DOUGLAS IRA ROSEN MD (NPI 1821081027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508131715 NPI number — DENTAL BRIGHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL BRIGHT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508131715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5711 HILLCROFT AVE
Provider Second Line Business Mailing Address:
SUITE A2
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-783-6060
Provider Business Mailing Address Fax Number:
713-783-6069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5711 HILLCROFT AVE
Provider Second Line Business Practice Location Address:
SUITE A2
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-783-6060
Provider Business Practice Location Address Fax Number:
713-783-6069
Provider Enumeration Date:
03/21/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FALAHAT
Authorized Official First Name:
ALI
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
713-783-6060

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  18923 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)