Provider Demographics
NPI:1831463777
Name:ROTHSTEIN, IRA (DMD, MS)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SE 5TH AVE
Mailing Address - Street 2:UNIT 906
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2984
Mailing Address - Country:US
Mailing Address - Phone:954-829-4757
Mailing Address - Fax:
Practice Address - Street 1:8903 GLADES RD
Practice Address - Street 2:SUITE D6
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4074
Practice Address - Country:US
Practice Address - Phone:561-483-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics