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Organization

BENJAMIN D ROSENBERG DDS INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS SHELLI G CRANE (OFFICE MANAGER)
(417) 781-2220
Entity
Organization

Contact information

Practice address
2602 S PICHER AVE, JOPLIN, MO 64804-1641
(417) 781-2220
(417) 781-1308
Mailing address
PO BOX 2788, JOPLIN, MO 64803-2788
(417) 781-2220
(417) 781-1308

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10670
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1932186905
INDDIVIDUAL NPI
Enumeration date
02/16/2015
Last updated
02/16/2015
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