Provider Demographics
NPI:1588221659
Name:ROSNER, ELISSA
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:
Last Name:ROSNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14443 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3309
Mailing Address - Country:US
Mailing Address - Phone:216-382-2121
Mailing Address - Fax:
Practice Address - Street 1:14443 CEDAR RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3309
Practice Address - Country:US
Practice Address - Phone:216-382-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0257511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice