Provider Demographics
NPI:1336313063
Name:ROSENBAUM, RONALD E (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:ROSENBAUM
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 1:2231 N UNIVERSITY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3611
Mailing Address - Country:US
Mailing Address - Phone:954-981-5600
Mailing Address - Fax:954-981-1293
Practice Address - Street 1:2231 N UNIVERSITY DR
Practice Address - Street 2:SUITE A
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-981-5600
Practice Address - Fax:954-981-1293
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075744600Medicaid