Provider Demographics
NPI:1427256411
Name:WESTCHESTER DENTISTRY, INC.
Entity type:Organization
Organization Name:WESTCHESTER DENTISTRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-753-7734
Mailing Address - Street 1:1575 V. ODOM BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320
Mailing Address - Country:US
Mailing Address - Phone:330-753-7734
Mailing Address - Fax:330-753-5888
Practice Address - Street 1:1575 V. ODOM BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320
Practice Address - Country:US
Practice Address - Phone:330-753-7734
Practice Address - Fax:330-753-5888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTCHESTER DENTISTRY, INC. (DBA: AKRON FAMILY DENTAL CENTER)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20624122300000X
OH19135122300000X, 1223G0001X
OH21832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0525935Medicaid