Provider Demographics
NPI:1679774012
Name:STEPHEN M ROSENBERG, DMD, PA
Entity Type:Organization
Organization Name:STEPHEN M ROSENBERG, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-224-1851
Mailing Address - Street 1:410 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3483
Mailing Address - Country:US
Mailing Address - Phone:603-224-1851
Mailing Address - Fax:603-224-7240
Practice Address - Street 1:410 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3483
Practice Address - Country:US
Practice Address - Phone:603-224-1851
Practice Address - Fax:603-224-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty