Provider Demographics
NPI:1699852137
Name:ROSENTHAL, MARC S (DMD, MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:S
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 FOUR MILE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1940
Mailing Address - Country:US
Mailing Address - Phone:570-323-1900
Mailing Address - Fax:570-323-6079
Practice Address - Street 1:1701 FOUR MILE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1940
Practice Address - Country:US
Practice Address - Phone:520-323-1900
Practice Address - Fax:520-323-6079
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020170201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U85631Medicare UPIN