# GORDON B ROSENGREN, DDS, INC, PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730282054
- **Authorized official:** DR. GORDON B. ROSENGREN DDS (PRESIDENT)
- **Authorized official phone:** (253) 859-0123

## Contact information

- **Practice address:** 24722 104TH AVE SE, SUITE 201, KENT, WA 98030-5322
- **Practice address phone:** (253) 859-0123
- **Practice address fax:** (253) 859-5864
- **Mailing address:** 24722 104TH AVE SE, SUITE 201, KENT, WA 98030-5322
- **Mailing address phone:** (253) 859-0123
- **Mailing address fax:** (253) 859-5864

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DE00004446 | WA | Yes |

## Other

- **Enumeration date:** 09/06/2006
- **Last updated:** 08/22/2020