Basic Information
| Provider Information | |||||||||
| NPI: | 1003806191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | TOMMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 753 STATE AVE | ||||||||
| Address2: | STE 402 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661012516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133213999 | ||||||||
| FaxNumber: | 9133215766 | ||||||||
| Practice Location | |||||||||
| Address1: | 753 STATE AVE | ||||||||
| Address2: | STE 402 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661012516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133213999 | ||||||||
| FaxNumber: | 9133215766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 6742 | KS | Y | Dental Providers | Dentist |
No ID Information.