Provider Demographics
NPI:1265472245
Name:ROSENFELD, JERRY N (DDS)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:N
Last Name:ROSENFELD
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 1:27 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2642
Mailing Address - Country:US
Mailing Address - Phone:860-658-9333
Mailing Address - Fax:
Practice Address - Street 1:39 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3805
Practice Address - Country:US
Practice Address - Phone:860-674-0707
Practice Address - Fax:860-678-8440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT41181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice