Provider Demographics
NPI:1275896763
Name:FELD/ROSENBERG-A DENTAL PARTNERSHIP
Entity Type:Organization
Organization Name:FELD/ROSENBERG-A DENTAL PARTNERSHIP
Other - Org Name:SOUTHEAST DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-771-7777
Mailing Address - Street 1:4332 SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-2800
Mailing Address - Country:US
Mailing Address - Phone:323-771-7777
Mailing Address - Fax:323-562-5209
Practice Address - Street 1:4332 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-2800
Practice Address - Country:US
Practice Address - Phone:323-771-7777
Practice Address - Fax:323-562-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty