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General NPI Number Information
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NPI Number | 1679966972
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Entity Type | Individual
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Provider Name | MAX ROSENSTOCK EMMERLING DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 1969 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3765
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Country | US
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Telephone | 312-864-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 W HARRISON ST CLINIC D, ORAL MAXILLOFACIAL SURGERY
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City | CHICAGO
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State | IL
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Zip | 60612-3714
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Country | US
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Telephone | 312-864-5159
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Fax | 312-864-9827
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 036.156717
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License Number State | IL
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