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General NPI Number Information
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NPI Number | 1518251412
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Entity Type | Organization
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Legal Business Name | HEIDI L. ROSENTHAL, DDS, LLC
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 815 SCHNEIDER ST SE
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City | NORTH CANTON
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State | OH
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Zip | 44720-3745
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Country | US
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Telephone | 330-499-2367
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Fax |
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Provider Business Mailing Address
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Address Line | 815 SCHNEIDER ST SE
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City | NORTH CANTON
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State | OH
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Zip | 44720-3745
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Country | US
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Telephone | 330-499-2367
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEIDI L ROSENTHAL
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Credential | DDS
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Telephone | 330-256-4275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30019212
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License Number State | OH
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