Provider Demographics
NPI:1114189875
Name:ROTBLATT, MARVIN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:L
Last Name:ROTBLATT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 RAVENNA RD
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2706
Mailing Address - Country:US
Mailing Address - Phone:330-425-4447
Mailing Address - Fax:330-425-4447
Practice Address - Street 1:11660 RAVENNA RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2706
Practice Address - Country:US
Practice Address - Phone:330-425-4447
Practice Address - Fax:330-425-4447
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist