Healthcare Provider Details

I. General information

NPI: 1427256411
Provider Name (Legal Business Name): WESTCHESTER DENTISTRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 V. ODOM BLVD
AKRON OH
44320
US

IV. Provider business mailing address

1575 V. ODOM BLVD
AKRON OH
44320
US

V. Phone/Fax

Practice location:
  • Phone: 330-753-7734
  • Fax: 330-753-5888
Mailing address:
  • Phone: 330-753-7734
  • Fax: 330-753-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20624
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number19135
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number21832
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19135
License Number StateOH

VIII. Authorized Official

Name: JEFFREY S. ROSENTHAL
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 330-753-7734