NPIMap

Organization Active NPI

Lakewood Dental Group, Jeffrey S Rosenthal DDS Inc

  • General Practice Dentistry
  • Lakewood, OH
National Provider Identifier
1902327315
Registry record updated Jul 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LAKEWOOD DENTAL GROUP, JEFFREY S ROSENTHAL DDS INC
Practice address
17117 Detroit Ave
Lakewood, OH 44107-3622
Phone
(216) 221-0300
NPI assigned
Jul 6, 2017
Last updated
Jul 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy J Shreves
Title
Credentialing Manager
Phone
(440) 352-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

17117 Detroit Ave
Lakewood, OH 44107-3622

Mailing address

9571 Mentor Ave
Mentor, OH 44060-4521
Phone (440) 352-5700

National Provider Directory

National Provider Directory

Locations

17117 Detroit Ave
Lakewood, OH 44107
Phone (216) 221-0300

9571 Mentor Ave
Mentor, OH 44060
Phone (440) 352-5700

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499299200000",
    "number": "1902327315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9571 MENTOR AVE",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604521",
            "telephone_number": "440-352-5700",
            "fax_number": "440-352-5721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17117 DETROIT AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441073622",
            "telephone_number": "216-221-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD DENTAL GROUP, JEFFREY S ROSENTHAL DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-06",
        "last_updated": "2017-07-06",
        "status": "A",
        "authorized_official_last_name": "SHREVES",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "440-352-5700"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.

Verify at the official NPI Registry.