Individual
DR. ELIZABETH VIVIAN ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
24760 HOSPITAL DR., RED LAKE, MN 56671
(218) 679-0119
Mailing address
6110 SAN MARCOS DR, FARMINGTON, NM 87402-1161
(530) 902-5139
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
59821
CA
Other
Enumeration date
10/06/2010
Last updated
03/16/2020
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