Provider Demographics
NPI:1457139040
Name:RICHARD G. ROSENBLATT, DMD, P.C.
Entity Type:Organization
Organization Name:RICHARD G. ROSENBLATT, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-234-4405
Mailing Address - Street 1:101 N WAUKEGAN RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1686
Mailing Address - Country:US
Mailing Address - Phone:847-234-4405
Mailing Address - Fax:
Practice Address - Street 1:101 N WAUKEGAN RD STE 1200
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1686
Practice Address - Country:US
Practice Address - Phone:847-234-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental