Provider Demographics
NPI:1467879155
Name:SCOTT I ROTHBART DDS LLC
Entity Type:Organization
Organization Name:SCOTT I ROTHBART DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROTHBART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-566-5555
Mailing Address - Street 1:1223 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1235
Mailing Address - Country:US
Mailing Address - Phone:610-566-5555
Mailing Address - Fax:610-566-4499
Practice Address - Street 1:1223 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1235
Practice Address - Country:US
Practice Address - Phone:610-566-5555
Practice Address - Fax:610-566-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFR1418664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFR1418664OtherDEA