MEDICARE: DR. ARNOLD HERMAN ROSENHECK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22DI00828800	NJ

General Provider Information

NPI Number	:	1306809942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARNOLD HERMAN ROSENHECK DMD

Provider Business Mailing Address
First Line	:	110 BERGEN ST
Second Line	:	UMDNJ- NEW JERSEY DENTAL SCHOOL- RM B813
City	:	NEWARK
State	:	NJ
Zip	:	07103-2495
Country	:	US
Telephone Number	:	973-972-3620
Fax Number	:	973-972-3689

Provider Business Practice Location Address
First Line	:	110 BERGEN ST
Second Line	:	UMDNJ- NEW JERSEY DENTAL SCHOOL- RM B813
City	:	NEWARK
State	:	NJ
Zip	:	07103-2495
Country	:	US
Telephone Number	:	973-972-3620
Fax Number	:	973-972-3689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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