Provider Demographics
NPI:1689723215
Name:ROSENBAUER, PETER J (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:ROSENBAUER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MAIN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9222
Mailing Address - Country:US
Mailing Address - Phone:973-335-0650
Mailing Address - Fax:
Practice Address - Street 1:350 MAIN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9222
Practice Address - Country:US
Practice Address - Phone:973-335-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ127491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice