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General NPI Number Information
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NPI Number | 1992951594
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Entity Type | Organization
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Legal Business Name | KEITH ROTTMAN DDS PC
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 8140 SECOR RD
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City | LAMBERTVILLE
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State | MI
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Zip | 48144-8673
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Country | US
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Telephone | 734-854-2685
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Fax | 734-854-2687
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Provider Business Mailing Address
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Address Line | PO BOX 797
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City | LAMBERTVILLE
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State | MI
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Zip | 48144-0797
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Country | US
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Telephone | 734-854-2685
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Fax | 734-854-2687
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KEITH STEVEN ROTTMAN
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Credential | DDS
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Telephone | 734-854-2685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901013501
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License Number State | MI
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