MEDICARE: DR. LARRY GENE ROTHFUSS DDS

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	1223G0001X	General Practice Dentistry	5426	NE

General Provider Information

NPI Number	:	1316904089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY GENE ROTHFUSS DDS

Provider Business Mailing Address
First Line	:	2817 REILLY ST
Second Line	:	MCDS NA B
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7302
Country	:	US
Telephone Number	:	910-643-2196
Fax Number	:	910-396-7017

Provider Business Practice Location Address
First Line	:	2817 REILLY ST
Second Line	:	MCDS NA B
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7302
Country	:	US
Telephone Number	:	910-643-2196
Fax Number	:	910-396-7017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	08/30/2012

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