Organization
ORTHOODNTICS ONLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAREL A. ROSENBERG DDS,DMD (DOCTOR)
(310) 644-4412
Entity
Organization
Contact information
Practice address
11633 HAWTHORNE BLVD, SUITE #500, HAWTHORNE, CA 90250-2321
(310) 644-4412
(310) 644-7355
Mailing address
11633 HAWTHORNE BLVD, SUITE #500, HAWTHORNE, CA 90250-2321
(310) 644-4412
(310) 644-7355
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
17997
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102231
DHS INSURANCE
CA
01
—
105969
CIGNA
CA
01
—
189379
CIGNA
CA
01
—
259102
DELTACARE PMI
CA
01
—
549733
UNITED CONCORDIA
CA
01
—
7072
PACIFIC UNION
CA
01
—
98118
AETNA DMO
CA
01
—
B102
GOLDENWEST
CA
01
—
G90737-01
DENTICAL
CA
Enumeration date
02/14/2007
Last updated
08/22/2020
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