Healthcare Provider Details

I. General information

NPI: 1588905756
Provider Name (Legal Business Name): LAUREN ROTHSTEIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 NORTH MAIN STREET
SPRING VALLEY NY
10977
US

IV. Provider business mailing address

2992 WALDORF MARKET PL
WALDORF MD
20603-4874
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9300
  • Fax:
Mailing address:
  • Phone: 301-843-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16360
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: