Healthcare Provider Details

I. General information

NPI: 1821114802
Provider Name (Legal Business Name): BRETT AARON ROSENBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W INDIANTOWN RD SUITE 10
JUPITER FL
33458-6813
US

IV. Provider business mailing address

1102 W INDIANTOWN RD SUITE 10
JUPITER FL
33458-6813
US

V. Phone/Fax

Practice location:
  • Phone: 561-575-4556
  • Fax: 561-575-9499
Mailing address:
  • Phone: 561-575-4556
  • Fax: 561-575-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN15482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: