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Individual
MR. MARK S ROSEBUSH
Active
Individual
MR. MARK S ROSEBUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2009
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112421
—
MT
01
—
20094
BLUE CROSS BLUE SHIELD
MT
01
—
5511468
BLUE CHIP AFFILIATED COMP
MT
Enumeration date
10/04/2006
Last updated
03/13/2013
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