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General NPI Number Information
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NPI Number | 1285008771
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Entity Type | Organization
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Legal Business Name | MILL POND DENTAL PC
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 11 IRVING PL
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City | WOODMERE
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State | NY
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Zip | 11598-1256
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Country | US
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Telephone | 516-791-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 BROADWAY
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City | WOODMERE
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State | NY
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Zip | 11598
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Country | US
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Telephone | 516-791-2200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BARRY KENNETH ROZENBERG
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Credential | DDS
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Telephone | 516-791-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 038180
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License Number State | NY
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