Healthcare Provider Details

I. General information

NPI: 1174781603
Provider Name (Legal Business Name): IGOR ROITMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 26TH AVE
SAN FRANCISCO CA
94121-1127
US

IV. Provider business mailing address

292 26TH AVE
SAN FRANCISCO CA
94121-1127
US

V. Phone/Fax

Practice location:
  • Phone: 415-203-1068
  • Fax:
Mailing address:
  • Phone: 415-203-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: