Provider Demographics
NPI:1700817178
Name:ROSENBERG, DARA JEAN (DDS, MS, MPH)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:JEAN
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:DDS, MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183RD STREET AND THIRD AVENUE
Mailing Address - Street 2:ST BARNABAS HOSPITAL, DEPARTMENT OF DENTISTRY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:718-960-6498
Mailing Address - Fax:718-960-3663
Practice Address - Street 1:183RD STREET AND THIRD AVENUE
Practice Address - Street 2:ST BARNABAS HOSPITAL, DEPARTMENT OF DENTISTRY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-6498
Practice Address - Fax:718-960-3663
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist