Provider Demographics
NPI:1528197688
Name:LARRY ROSENTHAL,DMD,PC
Entity Type:Organization
Organization Name:LARRY ROSENTHAL,DMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-497-1728
Mailing Address - Street 1:7143 66TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7047
Mailing Address - Country:US
Mailing Address - Phone:718-497-1728
Mailing Address - Fax:718-497-2761
Practice Address - Street 1:7143 66TH PL
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7047
Practice Address - Country:US
Practice Address - Phone:718-497-1728
Practice Address - Fax:718-497-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00283876Medicaid