Provider Demographics
NPI:1114129780
Name:ROTHSTEIN, RICHARD L (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:ROTHSTEIN
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 1:11600 SW 96TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2593
Mailing Address - Country:US
Mailing Address - Phone:305-598-3384
Mailing Address - Fax:305-273-8967
Practice Address - Street 1:9485 SW 72ND ST
Practice Address - Street 2:A-100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3242
Practice Address - Country:US
Practice Address - Phone:305-598-3384
Practice Address - Fax:305-273-8967
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics