Provider Demographics
NPI:1780811224
Name:ROSENBERG MCGOWAN, CHRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:ROSENBERG MCGOWAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MCGOWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3404 BRETON CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2405
Mailing Address - Country:US
Mailing Address - Phone:404-228-8800
Mailing Address - Fax:
Practice Address - Street 1:171 GWINNETT DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5686
Practice Address - Country:US
Practice Address - Phone:770-963-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist