Provider Demographics
NPI:1962516765
Name:ROSENBERG, STEPHEN MAX (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MAX
Last Name:ROSENBERG
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 1:410 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3483
Mailing Address - Country:US
Mailing Address - Phone:603-224-1851
Mailing Address - Fax:603-224-7240
Practice Address - Street 1:410 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3483
Practice Address - Country:US
Practice Address - Phone:603-224-1851
Practice Address - Fax:603-224-7240
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice