Provider Demographics
NPI:1912918780
Name:ROSENBERG, NEIL A (DDS)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 BELLEVUE AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840
Mailing Address - Country:US
Mailing Address - Phone:401-849-2080
Mailing Address - Fax:
Practice Address - Street 1:172 BELLEVUE AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-849-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist