MEDICARE: MARC ROSENTHAL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8416	CO
2	1223G0001X	General Practice Dentistry	019.030533	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	840706945138	OTHER	CO	ROCKY MOUNTAIN HEALTH PLA

General Provider Information

NPI Number	:	1992794598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC ROSENTHAL DDS

Provider Business Mailing Address
First Line	:	641 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2032
Country	:	US
Telephone Number	:	719-589-5161
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2032
Country	:	US
Telephone Number	:	719-589-5161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/20/2022

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Directions to “ MARC ROSENTHAL DDS” Practice Location

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