Provider Demographics
NPI:1003037953
Name:ROBERT D. ROSENBERG, D.D.S., P.C.
Entity Type:Organization
Organization Name:ROBERT D. ROSENBERG, D.D.S., P.C.
Other - Org Name:CONNECTICUT ORTHODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-439-1022
Mailing Address - Street 1:914 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4229
Mailing Address - Country:US
Mailing Address - Phone:860-439-1022
Mailing Address - Fax:860-447-1766
Practice Address - Street 1:914 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4229
Practice Address - Country:US
Practice Address - Phone:860-439-1022
Practice Address - Fax:860-447-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT82231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty