Provider Demographics
NPI:1912283367
Name:GATEWAY DENTAL CENTER DR. WESLEY B ROSENTHAL AND ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:GATEWAY DENTAL CENTER DR. WESLEY B ROSENTHAL AND ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-222-4262
Mailing Address - Street 1:112 JEFFERSON AVENUE
Mailing Address - Street 2:SUITE 002
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-222-4262
Mailing Address - Fax:
Practice Address - Street 1:112 JEFFERSON AVE
Practice Address - Street 2:SUITE 002
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1861
Practice Address - Country:US
Practice Address - Phone:614-222-4262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300127521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty