Provider Demographics
NPI:1841723186
Name:ROSENBERG, RENEE (DDS)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
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 1:45 EISENHOWER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1452
Mailing Address - Country:US
Mailing Address - Phone:201-556-0006
Mailing Address - Fax:
Practice Address - Street 1:45 EISENHOWER DR STE 100
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1452
Practice Address - Country:US
Practice Address - Phone:201-556-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027990001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty