Individual
EDMUND J ROTTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
914 MAIN STREET, SOUTHBRIDGE, MA 01550
(508) 765-5985
Mailing address
914 MAIN STREET, SOUTHBRIDGE, MA 01550
(508) 765-5985
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12974
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000112
DELTA DENTAL
MA
05
—
0246409
—
MA
01
—
X10388DR
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/08/2007
Last updated
07/08/2007
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