Organization
LAKEWOOD DENTAL GROUP, JEFFREY S ROSENTHAL DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY J SHREVES (CREDENTIALING MANAGER)
(440) 352-5700
Entity
Organization
Contact information
Practice address
17117 DETROIT AVE, LAKEWOOD, OH 44107-3622
(216) 221-0300
Mailing address
9571 MENTOR AVE, MENTOR, OH 44060-4521
(440) 352-5700
(440) 352-5721
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/06/2017
Last updated
07/06/2017
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