Provider Demographics
NPI:1053426635
Name:ROTHERMICH, DANIEL H (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:ROTHERMICH
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 1:9000 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126
Mailing Address - Country:US
Mailing Address - Phone:314-842-7500
Mailing Address - Fax:314-842-8401
Practice Address - Street 1:9000 WATSON RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126
Practice Address - Country:US
Practice Address - Phone:314-842-7500
Practice Address - Fax:314-842-8401
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist