Provider Demographics
NPI:1386744241
Name:ROTHFUSZ, CRAIG E (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:E
Last Name:ROTHFUSZ
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 1:4020 COPPERFIELD COURT
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-235-3249
Mailing Address - Fax:
Practice Address - Street 1:7 W CALEDONIA AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045-0176
Practice Address - Country:US
Practice Address - Phone:701-636-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND040976Medicaid
AR3295676OtherDEA