Provider Demographics
NPI:1922529775
Name:ROTERT, ELLIOTT (DDS)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:ROTERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 W SAN JUAN WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6333
Mailing Address - Country:US
Mailing Address - Phone:303-795-6444
Mailing Address - Fax:
Practice Address - Street 1:10106 W SAN JUAN WAY STE 120
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6333
Practice Address - Country:US
Practice Address - Phone:303-795-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-02
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist