Provider Demographics
NPI:1003210436
Name:ROSENBUSCH, CLIVE
Entity Type:Individual
Prefix:
First Name:CLIVE
Middle Name:
Last Name:ROSENBUSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 GLADES RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7202
Mailing Address - Country:US
Mailing Address - Phone:561-394-7888
Mailing Address - Fax:
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:SUITE 307
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7202
Practice Address - Country:US
Practice Address - Phone:561-394-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist