Provider Demographics
NPI:1700239092
Name:ROTHERMEL FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:ROTHERMEL FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHERMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-783-2113
Mailing Address - Street 1:817 N AVENUE K
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3850
Mailing Address - Country:US
Mailing Address - Phone:337-783-2113
Mailing Address - Fax:337-783-2175
Practice Address - Street 1:817 N AVENUE K
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3850
Practice Address - Country:US
Practice Address - Phone:337-783-2113
Practice Address - Fax:337-783-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4310122300000X
LA6570122300000X
LA4418124Q00000X
LA3938124Q00000X
126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty