Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. GREGG LEE ROSE, DDS
Active Sole ProprietorDR. GREGG LEE ROSE, DDS is a Pediatric Dentistry healthcare provider located in CHAMPAIGN, Illinois. NPI 1730243171 is currently active in the NPPES registry. Verify at CMS.
Pediatric Dentistry · CHAMPAIGN, IL
Registration Details
- NPI Number
- 1730243171
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Dec 20, 2006 (19.692490489484 yrs)
- Last Updated
- Jul 8, 2007
- License
-
021.001507019.021040 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1715 BROADMOOR DRSUITE BCHAMPAIGN, IL, 618215983Browse IL providers · Browse ZIP 61821
- Phone
- 2173527337
- Primary Specialty
-
Pediatric Dentistry
1223P0221X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.