Provider Demographics
NPI:1942451604
Name:DENNIS ANDRESEN, GRANT ROSEN, D.D.S., INC.
Entity type:Organization
Organization Name:DENNIS ANDRESEN, GRANT ROSEN, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDRESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-424-0881
Mailing Address - Street 1:750 E ROMIE LN STE B
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4210
Mailing Address - Country:US
Mailing Address - Phone:831-424-0881
Mailing Address - Fax:831-424-1026
Practice Address - Street 1:750 E ROMIE LN STE B
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4210
Practice Address - Country:US
Practice Address - Phone:831-424-0881
Practice Address - Fax:831-424-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty