MEDICARE: BROOKLYN DENTAL GROUP, JEFFREY S. ROSENTHAL, DDS, INC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1952919714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN DENTAL GROUP, JEFFREY S. ROSENTHAL, DDS, INC.

Provider Business Mailing Address
First Line	:	4163 PEARL RD.
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109
Country	:	US
Telephone Number	:	216-860-0120
Fax Number	:	216-860-0479

Provider Business Practice Location Address
First Line	:	4163 PEARL RD.
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109
Country	:	US
Telephone Number	:	216-860-0120
Fax Number	:	216-860-0479

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MRS. GEORGIA PAPANDROPOULOS
Credential	:
Telephone Number	:	216-860-0120

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	07/12/2021

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