MEDICARE: DR. PAUL J ROSENBLITT DDS

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	21543	OH
2	1223G0001X	General Practice Dentistry	DN15591	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01593816	OTHER		UNITED CONCORDIA OF PA

General Provider Information

NPI Number	:	1679660146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J ROSENBLITT DDS

Provider Business Mailing Address
First Line	:	1148 EUCLID AVENUE
Second Line	:	SUITE 317
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1604
Country	:	US
Telephone Number	:	216-781-2444
Fax Number	:	216-781-0990

Provider Business Practice Location Address
First Line	:	1148 EUCLID AVENUE
Second Line	:	SUITE 317
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1604
Country	:	US
Telephone Number	:	216-781-2444
Fax Number	:	216-781-0990

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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