Provider Demographics
NPI:1801813530
Name:ROSEBERRY FAMILY DENTAL
Entity type:Organization
Organization Name:ROSEBERRY FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BALDO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-859-5600
Mailing Address - Street 1:224 ROSEBERRY ST
Mailing Address - Street 2:SUITE #7
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1687
Mailing Address - Country:US
Mailing Address - Phone:908-859-5600
Mailing Address - Fax:
Practice Address - Street 1:224 ROSEBERRY ST
Practice Address - Street 2:SUITE #7
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1687
Practice Address - Country:US
Practice Address - Phone:908-859-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI200671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty