Provider Demographics
NPI:1164658076
Name:ROBERT M. ROSENBERG, D.D.S., PA
Entity Type:Organization
Organization Name:ROBERT M. ROSENBERG, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHODONTIST
Authorized Official - Phone:207-594-2124
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:232 BROADWAY
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-0887
Mailing Address - Country:US
Mailing Address - Phone:207-594-2124
Mailing Address - Fax:207-594-2124
Practice Address - Street 1:232 BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2610
Practice Address - Country:US
Practice Address - Phone:207-594-2124
Practice Address - Fax:207-594-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME22911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1649343849OtherINDIVIDUAL NPI NUMBER
ME107630000OtherMAINECARE PROVIDER NUMBER