Provider Demographics
NPI:1063504314
Name:ROTHMAN, AMY R (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3906
Mailing Address - Country:US
Mailing Address - Phone:813-394-6033
Mailing Address - Fax:813-971-4872
Practice Address - Street 1:14201 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3906
Practice Address - Country:US
Practice Address - Phone:813-394-6033
Practice Address - Fax:813-971-4872
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice