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General NPI Number Information
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NPI Number | 1609283373
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Entity Type | Individual
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Provider Name | RONALD M ROSENBERG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 8308 OLD COURTHOUSE RD
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City | VIENNA
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State | VA
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Zip | 22182-3863
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Country | US
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Telephone | 703-893-1640
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Fax | 703-893-2004
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Provider Business Mailing Address
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Address Line | 8308 OLD COURTHOUSE RD
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City | VIENNA
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State | VA
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Zip | 22182-3863
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Country | US
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Telephone | 703-893-1640
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Fax | 703-893-2004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 040103887
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License Number State | VA
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