Provider Demographics
NPI:1780807842
Name:ROSENTHAL, LARRY R (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:R
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4151
Mailing Address - Country:US
Mailing Address - Phone:908-486-5278
Mailing Address - Fax:908-486-8543
Practice Address - Street 1:623 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4151
Practice Address - Country:US
Practice Address - Phone:908-486-5278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO14731001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice