Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D6595 | MN |
NPI | 1043209679 |
---|---|
Provider Name | Freeman Newton Rosenblum |
First Address | Saint Paul, MN 55102-1080 |
Second Address | Saint Paul, MN 55102-1080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 08/07/2007 |