MEDICARE: HAWTHORNE DENTAL ASSOCIATES PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1497180038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWTHORNE DENTAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	625 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-3401
Country	:	US
Telephone Number	:	973-423-4841
Fax Number	:	973-423-4840

Provider Business Practice Location Address
First Line	:	625 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-3401
Country	:	US
Telephone Number	:	973-423-4841
Fax Number	:	973-423-4840

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICTOR ROSENSON
Credential	:	DDS
Telephone Number	:	973-423-4841

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	09/13/2013

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