Healthcare Provider Details

I. General information

NPI: 1881983922
Provider Name (Legal Business Name): JAY NORMAN ROSENBERGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 GRANT ST S
BONDURANT IA
50035-4422
US

IV. Provider business mailing address

3902 GRANT ST S
BONDURANT IA
50035-4422
US

V. Phone/Fax

Practice location:
  • Phone: 515-967-7568
  • Fax: 515-967-0566
Mailing address:
  • Phone: 515-967-7568
  • Fax: 515-967-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5467
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: