Provider Demographics
NPI:1689848921
Name:THEODOSIOU & ROSENBAUM GENERAL DENTISTRY
Entity Type:Organization
Organization Name:THEODOSIOU & ROSENBAUM GENERAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-899-4455
Mailing Address - Street 1:3304 91ST ST
Mailing Address - Street 2:#1W
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1752
Mailing Address - Country:US
Mailing Address - Phone:718-899-4455
Mailing Address - Fax:
Practice Address - Street 1:3304 91ST ST
Practice Address - Street 2:#1W
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1752
Practice Address - Country:US
Practice Address - Phone:718-899-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty