Provider Demographics
NPI:1063755015
Name:ROSENWALD, JOSEPH MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARK
Last Name:ROSENWALD
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 1:18500 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0585
Mailing Address - Country:US
Mailing Address - Phone:301-947-2828
Mailing Address - Fax:301-947-0562
Practice Address - Street 1:18500 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0585
Practice Address - Country:US
Practice Address - Phone:301-947-2828
Practice Address - Fax:301-947-0562
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD84861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice