Individual provider Active NPI

Dan Rosen, DDS

  • General Practice Dentistry
  • Encino, CA
National Provider Identifier
1124143102
Registry record updated May 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
38742 Issued in CA
Practice address
16542 Ventura Blvd
Suite 505
Encino, CA 91436-2005
Phone
(818) 907-6736
Fax
(818) 907-0522
NPI assigned
Mar 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 2, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 38742 CA Primary

Addresses

Primary practice location

16542 Ventura Blvd
Suite 505
Encino, CA 91436-2005

Mailing address

16542 Ventura Blvd
Suite 505
Encino, CA 91436-2005
Phone (818) 907-6736

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130911000254 CA Practitioner - Oral Surgery 6608010707

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
38742CAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367452800000",
    "number": "1124143102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16542 VENTURA BLVD",
            "address_2": "SUITE 505",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362005",
            "telephone_number": "818-907-6736",
            "fax_number": "818-907-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16542 VENTURA BLVD",
            "address_2": "SUITE 505",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362005",
            "telephone_number": "818-907-6736",
            "fax_number": "818-907-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSEN",
        "first_name": "DAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2013-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "38742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

Verify at the official NPI Registry.