Provider Demographics
NPI:1962826750
Name:D.C. SURGICAL ARTS CENTER FOR ORAL AND FACIAL COSMETIC SURGERY LLC
Entity type:Organization
Organization Name:D.C. SURGICAL ARTS CENTER FOR ORAL AND FACIAL COSMETIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROTHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:347-989-2010
Mailing Address - Street 1:4301 50TH ST NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4364
Mailing Address - Country:US
Mailing Address - Phone:202-360-4032
Mailing Address - Fax:202-480-8149
Practice Address - Street 1:4301 50TH ST NW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4364
Practice Address - Country:US
Practice Address - Phone:202-360-4032
Practice Address - Fax:202-480-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10012251223S0112X
DCDEN10012231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty