Provider Demographics
NPI:1427199181
Name:ROSENTHAL, JEFFREY S (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 STREETSBORO PLZ
Mailing Address - Street 2:P.O. BOX 2006
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5635
Mailing Address - Country:US
Mailing Address - Phone:330-626-3814
Mailing Address - Fax:330-626-2169
Practice Address - Street 1:1727 STREETSBORO PLZ
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5635
Practice Address - Country:US
Practice Address - Phone:330-626-3814
Practice Address - Fax:330-626-2169
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH206241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2029361Medicaid