Provider Demographics
NPI:1730342304
Name:ROSARIO, DEENA ELAINE (RDH)
Entity type:Individual
Prefix:MS
First Name:DEENA
Middle Name:ELAINE
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HEALTH CENTER ROAD KYLE HEALTH CENTER 57752
Mailing Address - Street 2:PO BOX 540
Mailing Address - City:KYLE
Mailing Address - State:SD
Mailing Address - Zip Code:57752-0540
Mailing Address - Country:US
Mailing Address - Phone:605-455-8205
Mailing Address - Fax:605-455-1289
Practice Address - Street 1:1000 HEALTH CENTER ROAD KYLE HEALTH CENTER 57752
Practice Address - Street 2:#540
Practice Address - City:KYLE
Practice Address - State:SD
Practice Address - Zip Code:57752-0540
Practice Address - Country:US
Practice Address - Phone:605-455-8205
Practice Address - Fax:605-455-1289
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD954124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist