Healthcare Provider Details

I. General information

NPI: 1144669086
Provider Name (Legal Business Name): JOSEPH R. ROSENBERG, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 ROSEMEAD BLVD
SAN GABRIEL CA
91775-1936
US

IV. Provider business mailing address

6503 ROSEMEAD BLVD
SAN GABRIEL CA
91775-1936
US

V. Phone/Fax

Practice location:
  • Phone: 626-286-2156
  • Fax: 626-286-2598
Mailing address:
  • Phone: 626-286-2156
  • Fax: 626-286-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH R ROSENBERG
Title or Position: OWNER
Credential:
Phone: 626-286-2156