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General NPI Number Information
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NPI Number | 1083987911
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Entity Type | Organization
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Legal Business Name | FREMONT CHILDREN'S DENTISTRY, LLC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 1947 E MILITARY AVE
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City | FREMONT
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State | NE
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Zip | 68025-5467
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Country | US
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Telephone | 402-727-8700
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Fax | 402-727-8705
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Provider Business Mailing Address
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Address Line | 1947 E MILITARY AVE
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City | FREMONT
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State | NE
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Zip | 68025-5467
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Country | US
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Telephone | 402-727-8700
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Fax | 402-727-8705
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Authorized Official
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Title or Position | OWNER
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Name | DR. VINCENT ROTHE
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Credential | D.D.S
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Telephone | 402-727-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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