Provider Demographics
NPI:1538246020
Name:ROSENBAUM, SAMUEL DAVID (DDS)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DAVID
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 S FM 51
Mailing Address - Street 2:STE 300
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234
Mailing Address - Country:US
Mailing Address - Phone:940-626-0003
Mailing Address - Fax:940-626-0008
Practice Address - Street 1:2201 S FM 51
Practice Address - Street 2:STE 300
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:940-626-0003
Practice Address - Fax:940-626-0008
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice