Provider Demographics
NPI:1770718504
Name:BRONX PARK DENTAL PC
Entity type:Organization
Organization Name:BRONX PARK DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSMPH
Authorized Official - Phone:719-792-7972
Mailing Address - Street 1:2016 BRONXDALE AVE
Mailing Address - Street 2:#303
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3388
Mailing Address - Country:US
Mailing Address - Phone:718-792-7972
Mailing Address - Fax:718-792-8311
Practice Address - Street 1:2016 BRONXDALE AVE
Practice Address - Street 2:#303
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3388
Practice Address - Country:US
Practice Address - Phone:718-792-7972
Practice Address - Fax:718-792-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty