Provider Demographics
NPI:1881201820
Name:ROSENBLATT, ROSS LOUIS (DMD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:LOUIS
Last Name:ROSENBLATT
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 1:420 MONTICELLO AVE APT 414B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2686
Mailing Address - Country:US
Mailing Address - Phone:703-470-8074
Mailing Address - Fax:
Practice Address - Street 1:329 EDWIN DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4545
Practice Address - Country:US
Practice Address - Phone:757-499-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014172031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty