Provider Demographics
NPI:1629073390
Name:ROTHMAN, MARC GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:GEORGE
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1701 WYNNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3033
Mailing Address - Country:US
Mailing Address - Phone:856-829-9666
Mailing Address - Fax:856-829-4363
Practice Address - Street 1:1701 WYNNWOOD DR
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3033
Practice Address - Country:US
Practice Address - Phone:856-829-9666
Practice Address - Fax:856-829-4363
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017816001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery