Healthcare Provider Details

I. General information

NPI: 1730133075
Provider Name (Legal Business Name): RICHARD L. ROTHSTEIN, DMD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 SW 72ND ST SUITE A-100
MIAMI FL
33173-3214
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 305-598-3384
  • Fax: 305-598-3675
Mailing address:
  • Phone: 305-598-3384
  • Fax: 305-598-3675

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: MRS. LORI R ROTHSTEIN
Title or Position: OFFICE MANAGER
Credential: BA
Phone: 305-598-3384