Healthcare Provider Details

I. General information

NPI: 1386744241
Provider Name (Legal Business Name): CRAIG E ROTHFUSZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W CALEDONIA AVE
HILLSBORO ND
58045-0176
US

IV. Provider business mailing address

4020 COPPERFIELD COURT
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 701-636-4244
  • Fax:
Mailing address:
  • Phone: 701-235-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1750
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: