Provider Demographics
NPI:1942394549
Name:ROSEROOT, ALFRED (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:
Last Name:ROSEROOT
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9242 N. SPRINGFIELD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1518
Mailing Address - Country:US
Mailing Address - Phone:847-921-3370
Mailing Address - Fax:847-699-3370
Practice Address - Street 1:1455 E. GOLF RD. SUITE 216
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-699-3370
Practice Address - Fax:847-699-0383
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190157331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice