Provider Demographics
NPI:1780902999
Name:ROSENZWEIG, BRIAN JAY (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAY
Last Name:ROSENZWEIG
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 1:502 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4954
Mailing Address - Country:US
Mailing Address - Phone:541-382-6822
Mailing Address - Fax:541-382-1263
Practice Address - Street 1:502 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4954
Practice Address - Country:US
Practice Address - Phone:541-382-6822
Practice Address - Fax:541-382-1263
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD81351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics