Provider Demographics
NPI:1265836423
Name:ROTHER, RYAN CAPITAN
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CAPITAN
Last Name:ROTHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2260
Mailing Address - Country:US
Mailing Address - Phone:717-367-1336
Mailing Address - Fax:
Practice Address - Street 1:100 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2260
Practice Address - Country:US
Practice Address - Phone:717-367-1336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist