Provider Demographics
NPI:1891830725
Name:HILLSIDE DENTAL L.L.C.
Entity Type:Organization
Organization Name:HILLSIDE DENTAL L.L.C.
Other - Org Name:DR. JOHN H. ROSENBERG, JR.
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-744-0700
Mailing Address - Street 1:7241 N THORNYDALE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2045
Mailing Address - Country:US
Mailing Address - Phone:520-744-0700
Mailing Address - Fax:520-744-9964
Practice Address - Street 1:7241 N THORNYDALE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2045
Practice Address - Country:US
Practice Address - Phone:520-744-0700
Practice Address - Fax:520-744-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1245375195OtherINDIVIDUAL ID#