Provider Demographics
NPI:1255472965
Name:ROTTJAKOB, STEPHEN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:ROTTJAKOB
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:PO BOX 20685
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95160-0685
Mailing Address - Country:US
Mailing Address - Phone:408-268-2550
Mailing Address - Fax:408-268-2552
Practice Address - Street 1:6962 ALMADEN EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-3201
Practice Address - Country:US
Practice Address - Phone:408-268-2550
Practice Address - Fax:408-268-2552
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA346481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice