Individual
DR. KELLY S ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1100 MAIN ST, BUFFALO, NY 14209-2308
(716) 242-8200
Mailing address
1100 MAIN ST, BUFFALO, NY 14209-2308
(716) 242-8200
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
050914
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03376083
—
NY
Enumeration date
05/04/2006
Last updated
01/11/2012
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