Healthcare Provider Details

I. General information

NPI: 1356487102
Provider Name (Legal Business Name): ROSENBERG ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 FARMINGTON AVENUE
WEST HARTFORD CT
06107
US

IV. Provider business mailing address

55 TOWN LINE RD
WETHERSFIELD CT
06109
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-1199
  • Fax: 860-236-0099
Mailing address:
  • Phone: 860-529-9555
  • Fax: 860-563-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6524
License Number StateCT

VIII. Authorized Official

Name: DR. BARRY M ROSENBERG
Title or Position: OWNER PRESIDENT
Credential: DMD
Phone: 860-529-9555