Dr. Bruce E Rotter
Dentist Oral and Maxillofacial Surgeon
132 Crystal Gate Ln
Glen Carbon
, Illinois 62034-1141
Dr. Bruce E Rotter
Dentist Oral and Maxillofacial Surgeon
132 Crystal Gate Ln
Glen Carbon
, Illinois 62034-1141
(618) 288-0962
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About
Features
Specialties
- Dentist
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Dr. Bruce E Rotter
- 132 Crystal Gate Ln
- Glen Carbon, IL
- Zip : 62034-1141
- Phone : (618) 288-0962
Second Address
- Dr. Bruce E Rotter
- 132 Crystal Gate Ln
- Glen Carbon, IL
- Zip : 62034-1141
- Phone : (618) 288-0962
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 122300000X | Dentist | 019-018159 | IL |
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 021-001642 | IL |
National Provider Identifier
| NPI | 1043207046 |
|---|---|
| Provider Name | Dr. Bruce E Rotter |
| First Address | Glen Carbon, IL 62034-1141 |
| Second Address | Glen Carbon, IL 62034-1141 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/10/2005 |
| Last Update Date | 17/04/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1420102 | UNITED CONCORDIA PROV ID (01) | IL |
| 480442 | HEALTHLINK INS PROV ID (01) | IL |
| T95304 | (02) | ID |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.