Active NPI
Elizabeth Vivian Rose, DMD
- Dentist
- Red Lake, MN
National Provider Identifier
1871802934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 59821
- Practice address
- 24760 Hospital Dr.
Red Lake, MN 56671 - Phone
- (218) 679-0119
- NPI assigned
- Oct 6, 2010
- Last updated
- Mar 16, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 59821 | CA | Primary |
Addresses
Primary practice location
24760 Hospital Dr.
Red Lake, MN 56671
Mailing address
6110 San Marcos Dr
Farmington, NM 87402-1161
Phone (530) 902-5139
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59821 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584316800000",
"number": "1871802934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6110 SAN MARCOS DR",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "874021161",
"telephone_number": "530-902-5139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24760 HOSPITAL DR.",
"city": "RED LAKE",
"state": "MN",
"postal_code": "56671",
"telephone_number": "218-679-0119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "ELIZABETH",
"middle_name": "VIVIAN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-06",
"last_updated": "2020-03-16",
"certification_date": "2020-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "59821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Lake, MN
- Redlake Chemical Health Program Group Home (Redlake Group Home)
- Rayshayna Rose Roberts
- Juliana Renee Robertson, LICSW
- John Leo Millen Robinson, DDS
- Rons Transport LLC
- Ethan Ryberg, PHARMD
- Vanessa Ryberg, PHARMD
- Sanford Medical Center Fargo (Sanford Dialysis Red Lake)
- Beth A Schmid, RDH
- Jennifer Marie Schoenborn
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.