Provider Demographics
NPI:1295854784
Name:ROSEN, HOWARD DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:DAVID
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FORT LEE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3201
Mailing Address - Country:US
Mailing Address - Phone:201-836-5449
Mailing Address - Fax:
Practice Address - Street 1:112 FORT LEE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3201
Practice Address - Country:US
Practice Address - Phone:201-836-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101091700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist