Provider Demographics
NPI:1083150742
Name:DENTAL GROUP OF MENTOR, JEFFREY S. ROSENTHAL, DDS, INC
Entity Type:Organization
Organization Name:DENTAL GROUP OF MENTOR, JEFFREY S. ROSENTHAL, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-352-5700
Mailing Address - Street 1:9575 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4521
Mailing Address - Country:US
Mailing Address - Phone:440-352-5700
Mailing Address - Fax:440-352-5721
Practice Address - Street 1:9575 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4521
Practice Address - Country:US
Practice Address - Phone:440-352-5700
Practice Address - Fax:440-352-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0206241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty