Provider Demographics
NPI:1538212022
Name:ROSENQUIST, EDWARD A III (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:ROSENQUIST
Suffix:III
Gender:M
Credentials:DDS
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Mailing Address - Street 1:6046 FM 2920 RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2542
Mailing Address - Country:US
Mailing Address - Phone:254-213-6262
Mailing Address - Fax:254-213-6268
Practice Address - Street 1:5610 E CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 3
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5519
Practice Address - Country:US
Practice Address - Phone:301-869-2600
Practice Address - Fax:301-208-6657
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX146871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611613608OtherBUSINESS TAX ID#
TX14687OtherLICENSE NUMBER