Provider Demographics
NPI:1760550479
Name:JAMES W ROTTON DDS PA
Entity Type:Organization
Organization Name:JAMES W ROTTON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-234-6911
Mailing Address - Street 1:222 NORTH PINE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753
Mailing Address - Country:US
Mailing Address - Phone:870-234-6911
Mailing Address - Fax:870-234-7760
Practice Address - Street 1:222 NORTH PINE
Practice Address - Street 2:SUITE 4
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753
Practice Address - Country:US
Practice Address - Phone:870-234-6911
Practice Address - Fax:870-234-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110677631Medicaid