Provider Demographics
NPI:1760500839
Name:ROSENBERG, STEPHEN BROOKS (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BROOKS
Last Name:ROSENBERG
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 1:5458 TOWN CENTER RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1089
Mailing Address - Country:US
Mailing Address - Phone:561-393-1770
Mailing Address - Fax:561-393-1773
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:SUITE 9
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
Practice Address - Country:US
Practice Address - Phone:561-393-1770
Practice Address - Fax:561-393-1773
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 143701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice