Healthcare Provider Details

I. General information

NPI: 1881743219
Provider Name (Legal Business Name): DAVID L. ROTHMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 OCEAN AVENUE
SAN FRANCISCO CA
94127
US

IV. Provider business mailing address

2301 OCEAN AVENUE
SAN FRANCISCO CA
94127
US

V. Phone/Fax

Practice location:
  • Phone: 415-333-6811
  • Fax: 415-333-6813
Mailing address:
  • Phone: 415-333-6811
  • Fax: 415-333-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN 32171
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21634
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number32171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: