Provider Demographics
NPI:1366500803
Name:ROSE DENTAL GROUP PLLC
Entity type:Organization
Organization Name:ROSE DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-795-9643
Mailing Address - Street 1:11615 ANGUS RD
Mailing Address - Street 2:STE 210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78579
Mailing Address - Country:US
Mailing Address - Phone:512-795-9643
Mailing Address - Fax:512-795-9959
Practice Address - Street 1:11615 ANGUS RD
Practice Address - Street 2:STE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78579
Practice Address - Country:US
Practice Address - Phone:512-795-9643
Practice Address - Fax:512-795-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty