MEDICARE: THEODOSIOU & ROSENBAUM GENERAL DENTISTRY

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	043046	NY

General Provider Information

NPI Number	:	1689848921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEODOSIOU & ROSENBAUM GENERAL DENTISTRY

Provider Business Mailing Address
First Line	:	3304 91ST ST
Second Line	:	#1W
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1752
Country	:	US
Telephone Number	:	718-899-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 91ST ST
Second Line	:	#1W
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1752
Country	:	US
Telephone Number	:	718-899-4455
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. CRAIG ROSENBAUM
Credential	:	DDS
Telephone Number	:	718-899-4455

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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