Provider Demographics
NPI:1497833362
Name:MARK S ROSEBUSH DMD PC
Entity Type:Organization
Organization Name:MARK S ROSEBUSH DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSEBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-597-8909
Mailing Address - Street 1:BOX 529
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469
Mailing Address - Country:US
Mailing Address - Phone:978-597-8909
Mailing Address - Fax:978-597-8909
Practice Address - Street 1:162 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01469
Practice Address - Country:US
Practice Address - Phone:978-597-8909
Practice Address - Fax:978-597-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX04268OtherBLUE CROSS BLUE SHIELD