Individual
DR. RICHARD THOMAS ROSIECKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3101 CENTRAL AVE, LAKE STATION, IN 46405-2209
(219) 962-2148
Mailing address
3101 CENTRAL AVE, LAKE STATION, IN 46405-2209
(219) 962-2148
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008933
IN
Other
Enumeration date
03/14/2007
Last updated
07/09/2007
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