Individual
SHAUN ROTENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
305 W 12TH AVE, ROOM 4102, COLUMBUS, OH 43210-1267
(614) 292-4927
Mailing address
305 W 12TH AVE, ROOM 4102, COLUMBUS, OH 43210-1267
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
30-023160
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0466025
—
OH
Enumeration date
03/08/2010
Last updated
12/14/2021
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