Healthcare Provider Details

I. General information

NPI: 1427149830
Provider Name (Legal Business Name): CRAIG ROSENTHAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SOUTH AVE
GARWOOD NJ
07027-1343
US

IV. Provider business mailing address

305 SOUTH AVE
GARWOOD NJ
07027-1343
US

V. Phone/Fax

Practice location:
  • Phone: 908-789-3323
  • Fax: 908-317-9747
Mailing address:
  • Phone: 908-789-3323
  • Fax: 908-317-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10774
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: