Provider Demographics
NPI:1326562190
Name:TIMOTHY ROETTGER DMD INC
Entity Type:Organization
Organization Name:TIMOTHY ROETTGER DMD INC
Other - Org Name:CENTRAL DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROETTGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:530-370-4484
Mailing Address - Street 1:1955 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3605
Mailing Address - Country:US
Mailing Address - Phone:530-370-4484
Mailing Address - Fax:
Practice Address - Street 1:1955 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3605
Practice Address - Country:US
Practice Address - Phone:530-370-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental