Provider Demographics
NPI:1760806376
Name:ROTA DENTAL CORPORATION
Entity Type:Organization
Organization Name:ROTA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EUGUENE
Authorized Official - Last Name:ROTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-208-4297
Mailing Address - Street 1:10850 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4305
Mailing Address - Country:US
Mailing Address - Phone:310-208-4297
Mailing Address - Fax:888-206-6688
Practice Address - Street 1:10850 WILSHIRE BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4305
Practice Address - Country:US
Practice Address - Phone:310-208-4297
Practice Address - Fax:888-206-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA169781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty