Provider Demographics
NPI:1962683821
Name:ROSENBERG, MORTON K (DDS)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:K
Last Name:ROSENBERG
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 1:69-555 WAIKOLOA BEACH DR APT 1502
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-6701
Mailing Address - Country:US
Mailing Address - Phone:916-716-6858
Mailing Address - Fax:
Practice Address - Street 1:69-555 WAIKOLOA BEACH DR APT 1502
Practice Address - Street 2:
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-6701
Practice Address - Country:US
Practice Address - Phone:916-716-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist