Provider Demographics
NPI:1194393066
Name:ROTHMAN, REENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:
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 1:4060 N HILLS DR APT 6
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2454
Mailing Address - Country:US
Mailing Address - Phone:732-266-4284
Mailing Address - Fax:
Practice Address - Street 1:1700 N UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8970
Practice Address - Country:US
Practice Address - Phone:954-344-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN25998OtherFLORIDA DEPARTMENT OF HEALTH