Individual
CHRISTOPHER GREG ROSENVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
12641 OLD GLENN HWY STE 203, EAGLE RIVER, AK 99577
(907) 622-5437
Mailing address
12641 OLD GLENN HWY STE 203, EAGLE RIVER, AK 99577-7040
(907) 622-5437
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30-023455
OH
1223P0221X
Pediatric Dentistry
1484
AK
1223P0221X
Pediatric Dentistry
32861
TX
1223P0221X
Pediatric Dentistry
Primary
DEND1484
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1583802
—
AK
05
—
3767600
—
TX
Enumeration date
06/18/2011
Last updated
11/02/2019
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