Provider Demographics
NPI:1174544662
Name:ROSENBERG, MARC DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DAVID
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 1:57 W 57TH ST
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:212-758-7704
Mailing Address - Fax:212-759-7270
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 1402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-758-7704
Practice Address - Fax:212-759-7270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDDS0289861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice