MEDICARE: DR. JERRY HARRIS ROSENBAUM D.D.S.,M.S.

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	1223P0300X	Periodontics	4875	FL

General Provider Information

NPI Number	:	1659485787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY HARRIS ROSENBAUM D.D.S.,M.S.

Provider Business Mailing Address
First Line	:	3037 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-772-3600
Fax Number	:	954-772-3663

Provider Business Practice Location Address
First Line	:	3037 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4311
Country	:	US
Telephone Number	:	954-772-3600
Fax Number	:	954-772-3663

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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