MEDICARE: DR. MARVIN KERRY ROSENBERG D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	27362	CA

General Provider Information

NPI Number	:	1861639437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN KERRY ROSENBERG D.D.S.

Provider Business Mailing Address
First Line	:	12840 RIVERSIDE DR
Second Line	:	SUITE 504
City	:	STUDIO CITY
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-505-9095
Fax Number	:	818-505-1445

Provider Business Practice Location Address
First Line	:	12840 RIVERSIDE DR
Second Line	:	SUITE 504
City	:	STUDIO CITY
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-505-9095
Fax Number	:	818-505-1445

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

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/19/2009

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Directions to “ DR. MARVIN KERRY ROSENBERG D.D.S.” Practice Location

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