Provider Demographics
NPI:1174634638
Name:RICHARD M. ROTCHSTEIN,D.D.S. & CHRISTOPHER W. WASULKO D.M.D.
Entity Type:Organization
Organization Name:RICHARD M. ROTCHSTEIN,D.D.S. & CHRISTOPHER W. WASULKO D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTCHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-849-0822
Mailing Address - Street 1:13721 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8615
Mailing Address - Country:US
Mailing Address - Phone:704-849-0822
Mailing Address - Fax:704-849-0219
Practice Address - Street 1:13721 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WEDDINGTON
Practice Address - State:NC
Practice Address - Zip Code:28104-8615
Practice Address - Country:US
Practice Address - Phone:704-849-0822
Practice Address - Fax:704-849-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC62621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty