Provider Demographics
NPI:1639268519
Name:ROSENBERG, MARK I (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:I
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 1:2819 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1448
Mailing Address - Country:US
Mailing Address - Phone:248-683-2323
Mailing Address - Fax:248-683-0051
Practice Address - Street 1:2819 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1448
Practice Address - Country:US
Practice Address - Phone:248-683-2323
Practice Address - Fax:248-683-0051
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI121481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice