Healthcare Provider Details

I. General information

NPI: 1407061070
Provider Name (Legal Business Name): MARVIN ROSENTHAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 ROUTE 52
FISHKILL NY
12524-1563
US

IV. Provider business mailing address

831 ROUTE 52
FISHKILL NY
12524-1563
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-6749
  • Fax:
Mailing address:
  • Phone: 845-896-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number23724
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: