Provider Demographics
NPI:1942333539
Name:ROSENBLUM, BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34380 LAKEHURST DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2738
Mailing Address - Country:US
Mailing Address - Phone:248-553-0690
Mailing Address - Fax:
Practice Address - Street 1:10501 ALLEN RD
Practice Address - Street 2:STE 105
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1281
Practice Address - Country:US
Practice Address - Phone:313-383-3000
Practice Address - Fax:313-383-1631
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice