Provider Demographics
NPI:1033173042
Name:ROTZ, BARRY LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:LYNN
Last Name:ROTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 VIP DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7975
Mailing Address - Country:US
Mailing Address - Phone:724-935-0700
Mailing Address - Fax:724-935-2834
Practice Address - Street 1:108 VIP DR
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7975
Practice Address - Country:US
Practice Address - Phone:724-935-0700
Practice Address - Fax:724-935-2834
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025256-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice