Provider Demographics
NPI:1861733966
Name:ROZEMA, DONALD R (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:ROZEMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W WIEUCA RD NE
Mailing Address - Street 2:BLDG. 2, SUITE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3352
Mailing Address - Country:US
Mailing Address - Phone:404-252-4220
Mailing Address - Fax:404-252-4013
Practice Address - Street 1:300 W WIEUCA RD NE
Practice Address - Street 2:BLDG. 2, SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3352
Practice Address - Country:US
Practice Address - Phone:404-252-4220
Practice Address - Fax:404-252-4013
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist