Provider Demographics
NPI:1619137171
Name:ROSENBERG, JEFFREY BEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BEN
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4548
Mailing Address - Country:US
Mailing Address - Phone:386-253-3441
Mailing Address - Fax:386-253-7659
Practice Address - Street 1:1517 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4548
Practice Address - Country:US
Practice Address - Phone:386-253-3441
Practice Address - Fax:386-253-7659
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN74051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics