Provider Demographics
NPI:1023254885
Name:ROSALES, WILLIAM (RDA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E FAIRVIEW AVE
Mailing Address - Street 2:APTO #104
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1968
Mailing Address - Country:US
Mailing Address - Phone:818-546-2663
Mailing Address - Fax:
Practice Address - Street 1:13716 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2626
Practice Address - Country:US
Practice Address - Phone:818-988-2020
Practice Address - Fax:818-988-2004
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61378126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant