Provider Demographics
NPI:1356627186
Name:DR. JEFFREY M. ROSEN, DMD, PC
Entity Type:Organization
Organization Name:DR. JEFFREY M. ROSEN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-434-4077
Mailing Address - Street 1:16 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-4309
Mailing Address - Country:US
Mailing Address - Phone:610-434-4077
Mailing Address - Fax:610-434-3002
Practice Address - Street 1:16 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-4309
Practice Address - Country:US
Practice Address - Phone:610-434-4077
Practice Address - Fax:610-434-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020244L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental