Provider Demographics
NPI:1568651420
Name:ROTHSTEIN, BRUCE HARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HARRY
Last Name:ROTHSTEIN
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 1:1025 ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1210
Mailing Address - Country:US
Mailing Address - Phone:718-356-3339
Mailing Address - Fax:908-317-2659
Practice Address - Street 1:1025 ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1210
Practice Address - Country:US
Practice Address - Phone:718-356-3339
Practice Address - Fax:908-317-2659
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY032416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist