Provider Demographics
NPI:1649508417
Name:ROSENBERG, SALLY B (DDS)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:B
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NEW LONDON TPKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2246
Mailing Address - Country:US
Mailing Address - Phone:860-633-0486
Mailing Address - Fax:860-659-2126
Practice Address - Street 1:131 NEW LONDON TPKE
Practice Address - Street 2:SUITE 201
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2246
Practice Address - Country:US
Practice Address - Phone:860-633-0486
Practice Address - Fax:860-659-2126
Is Sole Proprietor?:No
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT07419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist