Provider Demographics
NPI:1295744118
Name:ROSENLICHT, JOEL LAWRENCE (DMD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:LAWRENCE
Last Name:ROSENLICHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 MIDDLE TUNRPIKE WEST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-1926
Mailing Address - Country:US
Mailing Address - Phone:860-649-2272
Mailing Address - Fax:860-533-1010
Practice Address - Street 1:483 MIDDLE TPKE W
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3863
Practice Address - Country:US
Practice Address - Phone:860-649-2272
Practice Address - Fax:860-533-1010
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22512Medicare UPIN