Individual
JEFFRY ALBERT ROSTAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
58 RACINE ST, MENASHA, WI 54952-3154
(920) 725-8213
(920) 725-8213
Mailing address
58 RACINE ST, MENASHA, WI 54952-3154
(920) 725-8213
(920) 725-8213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5214
WI
124Q00000X
Dental Hygienist
5214
WI
Other
Enumeration date
05/13/2008
Last updated
05/13/2008
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