Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN9306 | FL |
NPI | 1003210436 |
---|---|
Provider Name | Clive Rosenbusch |
First Address | Boca Raton, FL 33431-7202 |
Second Address | Boca Raton, FL 33431-7202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2014 |
Last Update Date | 14/10/2014 |