Individual
CRAIG RUSSELL ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
107 S WALNUT ST, HICO, TX 76457-6298
(254) 796-4500
(254) 796-4508
Mailing address
PO BOX 658, HICO, TX 76457-0658
(254) 796-4500
(254) 796-4508
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6091
OK
1223G0001X
General Practice Dentistry
2007018212
MO
1223G0001X
General Practice Dentistry
Primary
27248
TX
Other
Enumeration date
07/19/2007
Last updated
12/14/2011
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