Provider Demographics
NPI:1447852488
Name:ROSWELL SKIN CENTER, LLC
Entity type:Organization
Organization Name:ROSWELL SKIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:COMETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-553-9308
Mailing Address - Street 1:400 N PENNSYLVANIA AVE STE 920
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4779
Mailing Address - Country:US
Mailing Address - Phone:575-208-2509
Mailing Address - Fax:
Practice Address - Street 1:400 N PENNSYLVANIA AVE STE 920
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4779
Practice Address - Country:US
Practice Address - Phone:575-208-2509
Practice Address - Fax:575-265-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty