Provider Demographics
NPI:1336554765
Name:COMPREHENSIVE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-935-0700
Mailing Address - Street 1:108 VIP DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7975
Mailing Address - Country:US
Mailing Address - Phone:724-935-0700
Mailing Address - Fax:724-935-2834
Practice Address - Street 1:108 VIP DR
Practice Address - Street 2:SUITE 105
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7975
Practice Address - Country:US
Practice Address - Phone:724-935-0700
Practice Address - Fax:724-935-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025256-L332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7067960001Medicare NSC