MEDICARE: DR. KATHRYN CYRENA ROSENBAUM D.M.D.

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	6035	KY

General Provider Information

NPI Number	:	1396769022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN CYRENA ROSENBAUM D.M.D.

Provider Business Mailing Address
First Line	:	6415 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3040
Country	:	US
Telephone Number	:	502-231-0806
Fax Number	:	502-231-0878

Provider Business Practice Location Address
First Line	:	6415 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3040
Country	:	US
Telephone Number	:	502-231-0806
Fax Number	:	502-231-0878

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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