Healthcare Provider Details

I. General information

NPI: 1295954865
Provider Name (Legal Business Name): TED M ROSNER DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 MAIN ST
LUMBERTON NJ
08048-5043
US

IV. Provider business mailing address

PO BOX 98
LUMBERTON NJ
08048-0098
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-8200
  • Fax: 609-261-8880
Mailing address:
  • Phone: 609-261-8200
  • Fax: 609-261-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01292101
License Number StateNJ

VIII. Authorized Official

Name: DR. TED M ROSNER
Title or Position: PRESIDENT
Credential: DMD
Phone: 609-261-8200