Provider Demographics
NPI:1184789885
Name:CLIVE ROSENBUSCH
Entity type:Organization
Organization Name:CLIVE ROSENBUSCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:561-394-7888
Mailing Address - Street 1:2499 GLADES RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7209
Mailing Address - Country:US
Mailing Address - Phone:561-394-7888
Mailing Address - Fax:561-394-4007
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:SUITE 307
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-394-7888
Practice Address - Fax:561-394-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-25
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty