Provider Demographics
NPI:1972519668
Name:ROTMAN, MARTIN I (DDS)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:I
Last Name:ROTMAN
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 1:10321 ROCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5353
Mailing Address - Country:US
Mailing Address - Phone:310-551-0722
Mailing Address - Fax:310-551-1322
Practice Address - Street 1:9911 W PICO BLVD
Practice Address - Street 2:SUITE 1500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2703
Practice Address - Country:US
Practice Address - Phone:310-843-0909
Practice Address - Fax:310-551-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice