Paul Rotzal, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS044129 Issued in PA

Practice address

230 N Keswick Ave
Glenside, PA 19038-4804

Phone

(215) 885-4252

Fax

(215) 885-7487

NPI assigned

Apr 6, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dynamic Modern Dentistry at Keswick Village PLLC

  dba Dynamic Modern Dentistry

  • General Practice Dentistry
  • Glenside, PA
  • NPI 1336000298
  NPD
• Dynamic Modern Dentistry

  • General Practice Dentistry
  • Glenside, PA
  • NPI 1578714812
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1619662574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 N KESWICK AVE",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190384804",
            "telephone_number": "215-885-4252",
            "fax_number": "215-885-7487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 N KESWICK AVE",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190384804",
            "telephone_number": "215-885-4252",
            "fax_number": "215-885-7487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTZAL",
        "first_name": "PAUL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-06",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS044129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Felicia P. Roche, LPC
• Keyoni Rogers
• Melvin L. Rogers Jr., PH.D.
• Rebecca Lynn Rose, LCSW
• Arlene Schnee Rosen, LMFT
• Susan M Rotzal, DMD, MAGD
• Erica Rup, PTA
• Mary Suzanne Ryan, LCSW
• Benjamin Sacks, PT, DPT
• Todd Sagin, M.D.

• General Practice Dentistry in Glenside, PA
• Providers in Glenside, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.