Provider Demographics
NPI:1518251412
Name:HEIDI L. ROSENTHAL, DDS, LLC
Entity Type:Organization
Organization Name:HEIDI L. ROSENTHAL, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-256-4275
Mailing Address - Street 1:815 SCHNEIDER ST SE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3745
Mailing Address - Country:US
Mailing Address - Phone:330-499-2367
Mailing Address - Fax:
Practice Address - Street 1:815 SCHNEIDER ST SE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-3745
Practice Address - Country:US
Practice Address - Phone:330-499-2367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30019212OtherDEA REGISTRATION