Provider Demographics
NPI:1952576282
Name:ROBERT A. ROSENFELD DDS (A PROFESSIONAL DENTAL CORPORATION)
Entity Type:Organization
Organization Name:ROBERT A. ROSENFELD DDS (A PROFESSIONAL DENTAL CORPORATION)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-755-1189
Mailing Address - Street 1:116 W PLAZA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1124
Mailing Address - Country:US
Mailing Address - Phone:858-755-1189
Mailing Address - Fax:858-755-6406
Practice Address - Street 1:116 W PLAZA ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1124
Practice Address - Country:US
Practice Address - Phone:858-755-1189
Practice Address - Fax:858-755-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27675261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental