Provider Demographics
NPI:1467443523
Name:ROSENTHAL, WESLEY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:M
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 1:2355 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1523
Mailing Address - Country:US
Mailing Address - Phone:925-837-8126
Mailing Address - Fax:
Practice Address - Street 1:2355 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1523
Practice Address - Country:US
Practice Address - Phone:925-837-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD27478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist