MEDICARE: DR. JOSEPH ORLEY ROSENBERG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6063	KS

General Provider Information

NPI Number	:	1104886563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ORLEY ROSENBERG DDS

Provider Business Mailing Address
First Line	:	205 N SANTA FE ST
Second Line	:
City	:	ST JOHN
State	:	KS
Zip	:	67576-2014
Country	:	US
Telephone Number	:	620-549-3323
Fax Number	:	620-549-3914

Provider Business Practice Location Address
First Line	:	205 N SANTA FE ST
Second Line	:
City	:	SAINT JOHN
State	:	KS
Zip	:	67576-2029
Country	:	US
Telephone Number	:	620-549-3323
Fax Number	:	620-549-3914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	07/08/2007

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