Individual
CRAIG MATTHEW ROSENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1 W LINCOLN ST, WAUPUN, WI 53963-1949
(929) 324-6256
Mailing address
714 HIGH LAND AVE APT 1, KEWASKUM, WI 53040-9179
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4558
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
WI
Enumeration date
10/10/2017
Last updated
10/10/2017
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