Provider Demographics
NPI:1871013151
Name:ROLLMAN, ERIC MASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MASON
Last Name:ROLLMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-0069
Mailing Address - Country:US
Mailing Address - Phone:480-255-4993
Mailing Address - Fax:
Practice Address - Street 1:107 S PINE ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1519
Practice Address - Country:US
Practice Address - Phone:641-664-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-094491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice