Richard Gary Rosenblatt, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019024962 Issued in IL

Practice address

1400 N Western Ave
Lake Forest, IL 60045-5404

Phone

(847) 234-4405

Fax

(847) 234-4585

NPI assigned

Mar 26, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433203200000",
    "number": "1558488155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 CAVELL AVE",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600352216",
            "telephone_number": "847-579-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N WESTERN AVE",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600455404",
            "telephone_number": "847-234-4405",
            "fax_number": "847-234-4585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBLATT",
        "first_name": "RICHARD",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2015-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019024962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gianna Rondinella, PA-C
• Jessica Root, AU.D.
• Theresa Lindsay Rose, D.O.
• Christina Mishu Rosean, AU.D.
• David Rosen, MD
• Sheri Ross, MD
• William Brian Ross, DDS
• Kimberly Rossin, PA
• Thea Justine Rossmiller, MSW, LCSW
• Sabrina Carlins Roth, PA-C

• General Practice Dentistry in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.