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BENJAMIN D ROSENBERG DDS INC

Pediatric Dentistry

Joplin, Missouri

Provider NPI: 1871984609

Organization Information:
Organization Name:  BENJAMIN D ROSENBERG DDS INC
Organization is not Subpart
Authorized Official:  SHELLI G CRANE  OFFICE MANAGER  417-7812220

Practice Location:
2602 S PICHER AVE  JOPLIN, MO 64804 US
Tel: 417-781-2220  Fax: 417-781-1308

Business Mailing Address:
PO BOX 2788  JOPLIN, MO 64803 US
Tel: 417-781-2220  Fax: 417-781-1308

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Dentist
Pediatric Dentistry
MO10670

Other Provider Identifiers:

IssuerNumberStateType
INDDIVIDUAL NPI193218690501
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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