Active NPI
Craig Matthew Rosenthal, DDS
- Dentist
- Waupun, WI
National Provider Identifier
1255841722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4558
- Practice address
- 1 W Lincoln St
Waupun, WI 53963-1949 - Phone
- (929) 324-6256
- NPI assigned
- Oct 10, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4558 | WI | Primary |
Addresses
Primary practice location
1 W Lincoln St
Waupun, WI 53963-1949
Mailing address
714 High Land Ave Apt 1
Kewaskum, WI 53040-9179
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | WI | NONE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507593600000",
"number": "1255841722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 HIGH LAND AVE APT 1",
"city": "KEWASKUM",
"state": "WI",
"postal_code": "530409179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 W LINCOLN ST",
"city": "WAUPUN",
"state": "WI",
"postal_code": "539631949",
"telephone_number": "929-324-6256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENTHAL",
"first_name": "CRAIG",
"middle_name": "MATTHEW",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-10",
"last_updated": "2017-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "4558",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NONE",
"identifier": "NONE",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waupun, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.