Provider Demographics
NPI:1356389852
Name:ROTHMAN, GERALD (DDS)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:ROTHMAN
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 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1313
Mailing Address - Country:US
Mailing Address - Phone:703-370-3012
Mailing Address - Fax:703-370-6005
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE # 204
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-370-3012
Practice Address - Fax:703-370-6005
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA053901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery