Provider Demographics
NPI:1992967574
Name:ROSENTHAL, TAMMY JODI (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:JODI
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 CHAGRIN BLVD
Mailing Address - Street 2:SUITE #170
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5535
Mailing Address - Country:US
Mailing Address - Phone:216-292-6565
Mailing Address - Fax:216-464-2894
Practice Address - Street 1:24100 CHAGRIN BLVD
Practice Address - Street 2:SUITE #170
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5535
Practice Address - Country:US
Practice Address - Phone:216-292-6565
Practice Address - Fax:216-464-2894
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH178211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice