Provider Demographics
NPI:1649280504
Name:ROSSWOG, ROBERT EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:ROSSWOG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 THOMPSON RUN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3367
Mailing Address - Country:US
Mailing Address - Phone:412-486-7344
Mailing Address - Fax:412-486-8299
Practice Address - Street 1:333 THOMPSON RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3367
Practice Address - Country:US
Practice Address - Phone:412-486-7344
Practice Address - Fax:412-486-8299
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027792L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA685049OtherBLUE CROSS/BLUE SHIELD
PABR2903664OtherDEA LICENSE