Provider Demographics
NPI:1861639437
Name:ROSENBERG, MARVIN KERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:KERRY
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12840 RIVERSIDE DR
Mailing Address - Street 2:SUITE 504
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3327
Mailing Address - Country:US
Mailing Address - Phone:818-505-9095
Mailing Address - Fax:818-505-1445
Practice Address - Street 1:12840 RIVERSIDE DR
Practice Address - Street 2:SUITE 504
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91607-3327
Practice Address - Country:US
Practice Address - Phone:818-505-9095
Practice Address - Fax:818-505-1445
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics