Provider Demographics
NPI:1285711408
Name:ROSENBLITT, JON CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:CHARLES
Last Name:ROSENBLITT
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 1:509 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1825
Mailing Address - Country:US
Mailing Address - Phone:203-348-1632
Mailing Address - Fax:
Practice Address - Street 1:509 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1825
Practice Address - Country:US
Practice Address - Phone:203-348-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0093351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice