Provider Demographics
NPI:1114376845
Name:CLEVELAND HEIGHTS DENTAL, JEFFREY ROSENTHAL, LLC
Entity Type:Organization
Organization Name:CLEVELAND HEIGHTS DENTAL, JEFFREY ROSENTHAL, LLC
Other - Org Name:CLEVELAND HEIGHTS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DINARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-791-5191
Mailing Address - Street 1:2460 FAIRMOUNT BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3171
Mailing Address - Country:US
Mailing Address - Phone:216-791-5191
Mailing Address - Fax:216-231-4933
Practice Address - Street 1:2460 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3171
Practice Address - Country:US
Practice Address - Phone:216-791-5191
Practice Address - Fax:216-231-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300159251223D0001X
OH206241223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty