Provider Demographics
NPI:1720128374
Name:ROTHSTEIN, TORREY
Entity Type:Individual
Prefix:DR
First Name:TORREY
Middle Name:
Last Name:ROTHSTEIN
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 1:210 SAN MATEO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-7172
Mailing Address - Country:US
Mailing Address - Phone:650-726-2144
Mailing Address - Fax:650-726-2726
Practice Address - Street 1:210 SAN MATEO RD STE 104
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-7172
Practice Address - Country:US
Practice Address - Phone:650-726-2144
Practice Address - Fax:650-726-2726
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD53860Medicaid