Provider Demographics
NPI:1679660146
Name:ROSENBLITT, PAUL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:ROSENBLITT
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 1:1148 EUCLID AVENUE
Mailing Address - Street 2:SUITE 317
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1604
Mailing Address - Country:US
Mailing Address - Phone:216-781-2444
Mailing Address - Fax:216-781-0990
Practice Address - Street 1:1148 EUCLID AVENUE
Practice Address - Street 2:SUITE 317
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1604
Practice Address - Country:US
Practice Address - Phone:216-781-2444
Practice Address - Fax:216-781-0990
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215431223G0001X
FLDN155911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
01593816OtherUNITED CONCORDIA OF PA