Provider Demographics
NPI:1275572539
Name:ROSENBERG, JOSEPH R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:ROSENBERG
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 1:6503 ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1936
Mailing Address - Country:US
Mailing Address - Phone:626-286-2156
Mailing Address - Fax:626-286-2598
Practice Address - Street 1:6503 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-1936
Practice Address - Country:US
Practice Address - Phone:626-286-2156
Practice Address - Fax:626-286-2598
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256211223G0001X
CA264791223G0001X
CA326321223G0001X
CA182621223P0106X
CA463931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223P0300XDental ProvidersDentistPeriodontics