Provider Demographics
NPI:1154413201
Name:ROSENTHAL, EDWARD ALAN (DDS PC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALAN
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MAYTIME DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2232
Mailing Address - Country:US
Mailing Address - Phone:516-937-1555
Mailing Address - Fax:516-938-5578
Practice Address - Street 1:16 MAYTIME DR
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2232
Practice Address - Country:US
Practice Address - Phone:516-937-1555
Practice Address - Fax:516-938-5578
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0418531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45-3787197OtherEIN