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General NPI Number Information
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NPI Number | 1811028079
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Entity Type | Individual
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Provider Name | FRED MICHAEL ROSEN DDS
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 350 ROUTE 73 S
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City | MARLTON
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State | NJ
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Zip | 08053-2004
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Country | US
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Telephone | 856-983-7732
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Fax | 856-988-0836
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Provider Business Mailing Address
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Address Line | 350 S STATE HIGHWAY 73
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City | MARLTON
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State | NJ
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Zip | 08053
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Country | US
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Telephone | 856-983-7732
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Fax | 856-988-0386
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 9714
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License Number State | NJ
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