MEDICARE: LAKE COUNTY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	020624	OH

General Provider Information

NPI Number	:	1396292405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE COUNTY DENTAL

Provider Business Mailing Address
First Line	:	9500 MENTOR AVE STE 280
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-8715
Country	:	US
Telephone Number	:	440-352-2887
Fax Number	:	440-352-7611

Provider Business Practice Location Address
First Line	:	9500 MENTOR AVE STE 280
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-8715
Country	:	US
Telephone Number	:	440-352-2887
Fax Number	:	440-352-7611

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JEFFREY ROSENTHAL
Credential	:	DDS
Telephone Number	:	440-352-2887

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

Similar Medicare Providers

1164425146 — DR. STEPHEN T CAROSELLO DDS
Practice Location Address:

9500 MENTOR AVE , STE 280
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44060-8715

Practice Phone: 440-352-2887
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1053973818 — DR. THOMAS JOSEPH SHONIKER DMD
Practice Location Address:

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1861069262 — THOMAS M RODRIGUEZ DMD
Practice Location Address:

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1609441484 — JILLIAN JANE WHETSEL
Practice Location Address:

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1699584961 — ERIN ELIZABETH JACKSON
Practice Location Address:

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Practice Fax:

1619623774 — SARAH VANVECHTEN
Practice Location Address:

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Directions to “LAKE COUNTY DENTAL ” Practice Location

Language	Start Address	Practice Location

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