Individual
DR. KENNETH S ROTSKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD,DDS
Contact information
Practice address
1034 S BRENTWOOD BLVD, SUITE 1010, SAINT LOUIS, MO 63117-1223
(314) 721-1010
Mailing address
1034 S BRENTWOOD BLVD, SUITE 1010, SAINT LOUIS, MO 63117-1223
(314) 721-1010
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
011149
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011149
DENTAL LICENSE
MO
Enumeration date
05/10/2007
Last updated
07/08/2007
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