Provider Demographics
NPI:1639333677
Name:ROSENTHAL, LESLEY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:R
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800A FIFTH AVE
Mailing Address - Street 2:STE 502
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-826-8662
Mailing Address - Fax:212-752-3945
Practice Address - Street 1:800A FIFTH AVE
Practice Address - Street 2:STE 502
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-826-8662
Practice Address - Fax:212-752-3945
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0406581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice