Provider Demographics
NPI:1144852302
Name:ROSENBERG DENTISTRY: JOE ROSENBERG DDS. PA
Entity type:Organization
Organization Name:ROSENBERG DENTISTRY: JOE ROSENBERG DDS. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:O
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-792-4205
Mailing Address - Street 1:1037 SHERIDAN SUITE D
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530
Mailing Address - Country:US
Mailing Address - Phone:620-792-4205
Mailing Address - Fax:620-603-6300
Practice Address - Street 1:1037 SHERIDAN SUITE D
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530
Practice Address - Country:US
Practice Address - Phone:620-792-4205
Practice Address - Fax:620-603-6300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOE O ROSENBERG DDS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty