Provider Demographics
NPI:1689898991
Name:ROTHBAUER, NANCY KAREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:KAREN
Last Name:ROTHBAUER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 VERNON AVE SW
Mailing Address - Street 2:.
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-2559
Mailing Address - Country:US
Mailing Address - Phone:253-582-9010
Mailing Address - Fax:
Practice Address - Street 1:12502 VERNON AVE SW
Practice Address - Street 2:.
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-2559
Practice Address - Country:US
Practice Address - Phone:253-582-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA77221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice