MEDICARE: BERNARD N ROTHMAN DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DI17816	NJ

General Provider Information

NPI Number	:	1306924550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNARD N ROTHMAN DDS PA

Provider Business Mailing Address
First Line	:	1701 WYNNWOOD DR
Second Line	:	SUITE 4
City	:	CINNAMINSON
State	:	NJ
Zip	:	08077-3033
Country	:	US
Telephone Number	:	856-829-9666
Fax Number	:	856-829-4363

Provider Business Practice Location Address
First Line	:	1701 WYNNWOOD DR
Second Line	:	SUITE 4
City	:	CINNAMINSON
State	:	NJ
Zip	:	08077-3033
Country	:	US
Telephone Number	:	856-829-9666
Fax Number	:	856-829-4363

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BERNARD N ROTHMAN
Credential	:
Telephone Number	:	215-224-7757

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/27/2008

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