1962672063 NPI number — FELD & ROSENBERG DENTAL PARTNERSHIP

Table of content: (NPI 1962672063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962672063 NPI number — FELD & ROSENBERG DENTAL PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FELD & ROSENBERG DENTAL PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAN GABRIEL VALLEY FAMILY DENTAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962672063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6503 ROSEMEAD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN GABRIEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91775-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-286-2156
Provider Business Mailing Address Fax Number:
626-286-2598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6503 ROSEMEAD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN GABRIEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91775-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-286-2156
Provider Business Practice Location Address Fax Number:
626-286-2598
Provider Enumeration Date:
03/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSENBERG
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
626-286-2156

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  25621 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)