Provider Demographics
NPI:1699822213
Name:ROTBLATT, SHOLI ABRAHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHOLI
Middle Name:ABRAHAM
Last Name:ROTBLATT
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:PO BOX 11000
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1000
Mailing Address - Country:US
Mailing Address - Phone:714-724-6564
Mailing Address - Fax:714-625-4999
Practice Address - Street 1:4301 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3525
Practice Address - Country:US
Practice Address - Phone:323-771-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist