Provider Demographics
NPI:1720179823
Name:ROTHIS, EMANUEL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:JAMES
Last Name:ROTHIS
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 1:22770 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2009
Mailing Address - Country:US
Mailing Address - Phone:586-775-0520
Mailing Address - Fax:586-775-2670
Practice Address - Street 1:22770 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2009
Practice Address - Country:US
Practice Address - Phone:586-775-0520
Practice Address - Fax:586-775-2670
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010075331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI053109OtherFIRST COMMONWEALTH ID #
MI4012430Medicaid
MI0002091OtherFORTIS ID NUMBER