1992951594 NPI number — KEITH ROTTMAN DDS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992951594 NPI number — KEITH ROTTMAN DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEITH ROTTMAN DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992951594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 797
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMBERTVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48144-0797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-854-2685
Provider Business Mailing Address Fax Number:
734-854-2687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8140 SECOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMBERTVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48144-8673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-854-2685
Provider Business Practice Location Address Fax Number:
734-854-2687
Provider Enumeration Date:
08/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROTTMAN
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
734-854-2685

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  2901013501 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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