Provider Demographics
NPI:1689361206
Name:OSTEICOECHEA R, ROSA VIRGINIA (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:VIRGINIA
Last Name:OSTEICOECHEA R
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11528 NW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1826
Mailing Address - Country:US
Mailing Address - Phone:305-905-3589
Mailing Address - Fax:
Practice Address - Street 1:4201 E BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-5053
Practice Address - Country:US
Practice Address - Phone:817-535-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX409881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty