Provider Demographics
NPI:1689698607
Name:ROTHSTEIN, MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ROTHSTEIN
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 1:235 TOWN CENTER PKWY
Mailing Address - Street 2:SUITE I
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5811
Mailing Address - Country:US
Mailing Address - Phone:619-448-9455
Mailing Address - Fax:619-562-7045
Practice Address - Street 1:235 TOWN CENTER PKWY
Practice Address - Street 2:SUITE I
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5811
Practice Address - Country:US
Practice Address - Phone:619-448-9455
Practice Address - Fax:619-562-7045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics