Provider Demographics
NPI:1295954865
Name:TED M ROSNER DMD, PA
Entity type:Organization
Organization Name:TED M ROSNER DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-261-8200
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-0098
Mailing Address - Country:US
Mailing Address - Phone:609-261-8200
Mailing Address - Fax:609-261-8880
Practice Address - Street 1:693 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5043
Practice Address - Country:US
Practice Address - Phone:609-261-8200
Practice Address - Fax:609-261-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012921011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069145Medicare PIN