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General NPI Number Information
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NPI Number | 1467879155
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Entity Type | Organization
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Legal Business Name | SCOTT I ROTHBART DDS LLC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1223 N PROVIDENCE RD
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City | MEDIA
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State | PA
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Zip | 19063-1235
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Country | US
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Telephone | 610-566-5555
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Fax | 610-566-4499
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Provider Business Mailing Address
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Address Line | 1223 N PROVIDENCE RD
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City | MEDIA
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State | PA
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Zip | 19063-1235
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Country | US
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Telephone | 610-566-5555
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Fax | 610-566-4499
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT I ROTHBART
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Credential | D.D.S.
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Telephone | 610-566-5555
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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 | FR1418664
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License Number State | PA
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