Individual
PAUL ANTHONY ROSSETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 327-3041
(708) 327-3489
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 512-5812
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019034743
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
019.034743
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2020
Last updated
11/14/2024
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