Provider Demographics
NPI:1548349202
Name:ROTWEIN, BENJAMIN ISADORE (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ISADORE
Last Name:ROTWEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PUUHONU WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2069
Mailing Address - Country:US
Mailing Address - Phone:808-649-5099
Mailing Address - Fax:808-649-5104
Practice Address - Street 1:135 PUUHONU WAY STE 100
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2069
Practice Address - Country:US
Practice Address - Phone:808-649-5099
Practice Address - Fax:808-649-5104
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO22994001223G0001X
AL62271223S0112X
HIDT-0-28981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice