Healthcare Provider Details

I. General information

NPI: 1114129780
Provider Name (Legal Business Name): RICHARD L. ROTHSTEIN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 SW 72ND ST A-100
MIAMI FL
33173-3242
US

IV. Provider business mailing address

11600 SW 96TH TER
MIAMI FL
33176-2593
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-3384
  • Fax: 305-273-8967
Mailing address:
  • Phone: 305-598-3384
  • Fax: 305-273-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: