Healthcare Provider Details

I. General information

NPI: 1174634638
Provider Name (Legal Business Name): RICHARD M. ROTCHSTEIN,D.D.S. & CHRISTOPHER W. WASULKO D.M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13721 PROVIDENCE RD
WEDDINGTON NC
28104-8615
US

IV. Provider business mailing address

13721 PROVIDENCE RD
WEDDINGTON NC
28104-8615
US

V. Phone/Fax

Practice location:
  • Phone: 704-849-0822
  • Fax: 704-849-0219
Mailing address:
  • Phone: 704-849-0822
  • Fax: 704-849-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6262
License Number StateNC

VIII. Authorized Official

Name: DR. RICHARD M. ROTCHSTEIN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 704-849-0822