Healthcare Provider Details

I. General information

NPI: 1124156476
Provider Name (Legal Business Name): DONALD P. ROTEN, DDS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 UNION ST
RIPLEY MS
38663-1718
US

IV. Provider business mailing address

307 UNION ST
RIPLEY MS
38663-1718
US

V. Phone/Fax

Practice location:
  • Phone: 662-837-4664
  • Fax: 662-837-1501
Mailing address:
  • Phone: 662-837-4664
  • Fax: 662-837-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberMS1279-67
License Number StateMS

VIII. Authorized Official

Name: DR. DONALD PERRIN ROTEN SR.
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 662-837-4664