Provider Demographics
NPI:1316904089
Name:ROTHFUSS, LARRY GENE (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GENE
Last Name:ROTHFUSS
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 1:2817 REILLY ST
Mailing Address - Street 2:MCDS NA B
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7302
Mailing Address - Country:US
Mailing Address - Phone:910-643-2196
Mailing Address - Fax:910-396-7017
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:MCDS NA B
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7302
Practice Address - Country:US
Practice Address - Phone:910-643-2196
Practice Address - Fax:910-396-7017
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice