Provider Demographics
NPI:1598863607
Name:ROSENTHAL, MICHAEL LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYNN
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 1:1805 NOVATO BLVD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2934
Mailing Address - Country:US
Mailing Address - Phone:415-892-6901
Mailing Address - Fax:415-892-8451
Practice Address - Street 1:1805 NOVATO BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-2934
Practice Address - Country:US
Practice Address - Phone:415-892-6901
Practice Address - Fax:415-892-8451
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice