Provider Demographics
NPI:1154610665
Name:ROSENTHAL, MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 GOLF CREST DR STE 209
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2698
Mailing Address - Country:US
Mailing Address - Phone:770-672-5629
Mailing Address - Fax:706-258-2320
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 140
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-924-4095
Practice Address - Fax:706-258-2320
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144841223S0112X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161675Medicaid