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General NPI Number Information
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NPI Number | 1962826750
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Entity Type | Organization
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Legal Business Name | D.C. SURGICAL ARTS CENTER FOR ORAL AND FACIAL COSMETIC SURGERY LLC
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 4301 50TH ST NW SUITE 200
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City | WASHINGTON
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State | DC
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Zip | 20016-4364
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Country | US
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Telephone | 202-360-4032
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Fax | 202-480-8149
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Provider Business Mailing Address
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Address Line | 4301 50TH ST NW SUITE 200
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City | WASHINGTON
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State | DC
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Zip | 20016-4364
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Country | US
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Telephone | 202-360-4032
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Fax | 202-480-8149
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SCOTT MICHAEL ROTHENBERG
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Credential | D.D.S., M.D.
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Telephone | 347-989-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN1001223
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DEN1001225
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License Number State | DC
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