Provider Demographics
NPI:1467518597
Name:ROSEN, JEFFREY MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
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 1:3131 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4812
Mailing Address - Country:US
Mailing Address - Phone:610-434-4077
Mailing Address - Fax:
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:SUITE 2100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4812
Practice Address - Country:US
Practice Address - Phone:610-434-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020244-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA272632731OtherFEDERAL TAX ID