Provider Demographics
NPI:1093729899
Name:ROSENWALD, JAMES F (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:ROSENWALD
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 1:1515 116TH AVE NE
Mailing Address - Street 2:SUITE #305
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3811
Mailing Address - Country:US
Mailing Address - Phone:425-454-4040
Mailing Address - Fax:425-454-4497
Practice Address - Street 1:1515 116TH AVE NE
Practice Address - Street 2:SUITE #305
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3811
Practice Address - Country:US
Practice Address - Phone:425-454-4040
Practice Address - Fax:425-454-4497
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA37331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911880419Medicare UPIN