Provider Demographics
NPI:1306924550
Name:BERNARD N ROTHMAN DDS PA
Entity type:Organization
Organization Name:BERNARD N ROTHMAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-224-7757
Mailing Address - Street 1:1701 WYNNWOOD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3033
Mailing Address - Country:US
Mailing Address - Phone:856-829-9666
Mailing Address - Fax:856-829-4363
Practice Address - Street 1:1701 WYNNWOOD DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3033
Practice Address - Country:US
Practice Address - Phone:856-829-9666
Practice Address - Fax:856-829-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI178161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA061742Medicare UPIN