Provider Demographics
NPI:1194830380
Name:RONALD M ROSENBERG DDS MS LTD
Entity Type:Organization
Organization Name:RONALD M ROSENBERG DDS MS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-893-1640
Mailing Address - Street 1:8308 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-893-1640
Mailing Address - Fax:703-893-2004
Practice Address - Street 1:8308 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE D
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-893-1640
Practice Address - Fax:703-893-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401003887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty