Provider Demographics
NPI:1326212937
Name:DAVID M. ROLSTEN, DDS, INC
Entity Type:Organization
Organization Name:DAVID M. ROLSTEN, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-342-3891
Mailing Address - Street 1:102 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-1104
Mailing Address - Country:US
Mailing Address - Phone:419-342-3891
Mailing Address - Fax:419-342-3897
Practice Address - Street 1:102 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1104
Practice Address - Country:US
Practice Address - Phone:419-342-3891
Practice Address - Fax:419-342-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300167891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1528135969OtherNPI TYPE 1