Provider Demographics
NPI:1376967711
Name:ROTRAMEL, GEORGE (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ROTRAMEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E PEMBROKE ST
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953-1427
Mailing Address - Country:US
Mailing Address - Phone:217-253-5222
Mailing Address - Fax:
Practice Address - Street 1:113 E PEMBROKE ST
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953-1427
Practice Address - Country:US
Practice Address - Phone:217-253-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-024565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist