Provider Demographics
NPI:1083906754
Name:ROBERT ROSENTHAL DDS PA
Entity Type:Organization
Organization Name:ROBERT ROSENTHAL DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-996-6551
Mailing Address - Street 1:220 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2930
Mailing Address - Country:US
Mailing Address - Phone:336-996-6551
Mailing Address - Fax:336-851-1737
Practice Address - Street 1:220 BROAD ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2930
Practice Address - Country:US
Practice Address - Phone:336-996-6551
Practice Address - Fax:336-851-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty