Provider Demographics
NPI:1720206725
Name:ROTHSTEIN, TED (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6792
Mailing Address - Country:US
Mailing Address - Phone:718-852-1551
Mailing Address - Fax:718-852-1894
Practice Address - Street 1:161 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6792
Practice Address - Country:US
Practice Address - Phone:718-852-1551
Practice Address - Fax:718-852-1894
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0260811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics