Provider Demographics
NPI:1568679389
Name:ROSENTHAL, PETER LAURENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:LAURENCE
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1254 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4924
Mailing Address - Country:US
Mailing Address - Phone:631-669-9194
Mailing Address - Fax:631-587-7911
Practice Address - Street 1:1254 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4924
Practice Address - Country:US
Practice Address - Phone:631-669-9194
Practice Address - Fax:631-587-7911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0318831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry