Healthcare Provider Details

I. General information

NPI: 1194359307
Provider Name (Legal Business Name): DR BARRY ROTZ AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 VIP DR STE 105
WEXFORD PA
15090-7975
US

IV. Provider business mailing address

108 VIP DR STE 105
WEXFORD PA
15090-7975
US

V. Phone/Fax

Practice location:
  • Phone: 724-935-0700
  • Fax: 724-935-2834
Mailing address:
  • Phone: 724-935-0700
  • Fax: 724-935-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: BARRY L ROTZ
Title or Position: MANAGING PARTNER
Credential: DMD
Phone: 724-935-0700