MEDICARE: TORREY DEL MAR DENTISTRY

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	37157	CA

General Provider Information

NPI Number	:	1639398712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TORREY DEL MAR DENTISTRY

Provider Business Mailing Address
First Line	:	13859 CARMEL VALLEY RD STE D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-5665
Country	:	US
Telephone Number	:	858-484-9090
Fax Number	:	858-484-9211

Provider Business Practice Location Address
First Line	:	13859 CARMEL VALLEY RD STE D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-5665
Country	:	US
Telephone Number	:	858-484-9090
Fax Number	:	858-484-9211

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JACK ALAN ROSENSON
Credential	:	D.M.D.
Telephone Number	:	858-484-9090

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/07/2008

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Directions to “TORREY DEL MAR DENTISTRY ” Practice Location

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