Provider Demographics
NPI:1992951594
Name:KEITH ROTTMAN DDS PC
Entity type:Organization
Organization Name:KEITH ROTTMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ROTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-854-2685
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-0797
Mailing Address - Country:US
Mailing Address - Phone:734-854-2685
Mailing Address - Fax:734-854-2687
Practice Address - Street 1:8140 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-8673
Practice Address - Country:US
Practice Address - Phone:734-854-2685
Practice Address - Fax:734-854-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013501261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental