Provider Demographics
NPI:1912099706
Name:JOE ROSENBERG D.D.S., P.A.
Entity Type:Organization
Organization Name:JOE ROSENBERG D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:ORLEY
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-549-3323
Mailing Address - Street 1:307 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:KS
Mailing Address - Zip Code:67576-2014
Mailing Address - Country:US
Mailing Address - Phone:620-549-3323
Mailing Address - Fax:620-549-3914
Practice Address - Street 1:307 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:KS
Practice Address - Zip Code:67576-2014
Practice Address - Country:US
Practice Address - Phone:620-549-3323
Practice Address - Fax:620-549-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty