Provider Demographics
NPI:1972922151
Name:MARK H ROSENBERG
Entity Type:Organization
Organization Name:MARK H ROSENBERG
Other - Org Name:BLUFF CREEK FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-422-4944
Mailing Address - Street 1:9351 STATE ROAD 144
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-5848
Mailing Address - Country:US
Mailing Address - Phone:317-422-4944
Mailing Address - Fax:317-422-4945
Practice Address - Street 1:9351 STATE ROAD 144
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-5848
Practice Address - Country:US
Practice Address - Phone:317-422-4944
Practice Address - Fax:317-422-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental