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General NPI Number Information
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NPI Number | 1306396551
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Entity Type | Organization
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Legal Business Name | ROTA ADVANCED DENTAL CARE
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 6210 WOODMEN PARK VW
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-2616
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Country | US
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Telephone | 719-598-1224
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Fax | 719-531-9430
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Provider Business Mailing Address
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Address Line | 6210 WOODMEN PARK VW
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-2616
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Country | US
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Telephone | 719-598-1224
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Fax | 719-531-9430
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Authorized Official
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Title or Position | OWNER
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Name | JOE ROTA
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Credential |
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Telephone | 719-598-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 104340
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License Number State | CO
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