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General NPI Number Information
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NPI Number | 1699852137
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Entity Type | Individual
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Provider Name | MARC S ROSENTHAL DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 1701 FOUR MILE DR
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1940
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Country | US
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Telephone | 520-323-1900
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Fax | 520-323-6079
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Provider Business Mailing Address
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Address Line | 1701 FOUR MILE DR
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1940
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Country | US
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Telephone | 570-323-1900
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Fax | 570-323-6079
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2002017020
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License Number State | MO
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