MEDICARE: DR. JEFFREY BEN 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	1223E0200X	Endodontics	DN7405	FL

General Provider Information

NPI Number	:	1619137171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY BEN ROSENBERG DDS

Provider Business Mailing Address
First Line	:	1517 MASON AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4548
Country	:	US
Telephone Number	:	386-253-3441
Fax Number	:	386-253-7659

Provider Business Practice Location Address
First Line	:	1517 MASON AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4548
Country	:	US
Telephone Number	:	386-253-3441
Fax Number	:	386-253-7659

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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