Provider Demographics
NPI:1639398712
Name:TORREY DEL MAR DENTISTRY
Entity Type:Organization
Organization Name:TORREY DEL MAR DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROSENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-484-9090
Mailing Address - Street 1:13859 CARMEL VALLEY RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5665
Mailing Address - Country:US
Mailing Address - Phone:858-484-9090
Mailing Address - Fax:858-484-9211
Practice Address - Street 1:13859 CARMEL VALLEY RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-5665
Practice Address - Country:US
Practice Address - Phone:858-484-9090
Practice Address - Fax:858-484-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty