Provider Demographics
NPI:1982058541
Name:RON ROTEM D.D.S., P.C.
Entity type:Organization
Organization Name:RON ROTEM D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-341-8500
Mailing Address - Street 1:355 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-7381
Mailing Address - Country:US
Mailing Address - Phone:732-341-8500
Mailing Address - Fax:732-341-3618
Practice Address - Street 1:355 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7381
Practice Address - Country:US
Practice Address - Phone:732-341-8500
Practice Address - Fax:732-341-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01843600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty