DR. BRUCE E ROTTER D.M.D. NPI 1043207046

NPI Information

NPI: 1043207046
Provider Name: DR. BRUCE E ROTTER, D.M.D.
Classification: Dentist - 1223S0112X
Specialization: Oral and Maxillofacial Surgery
Entity Type: Individual
Address: 132 CRYSTAL GATE LN
GLEN CARBON, IL
ZIP 62034
Phone: (618) 288-0962

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NPI Details

DR. Bruce E Rotter, D.M.D. is an oral and maxillofacial surgery dentist in Glen Carbon, IL. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Bruce E Rotter, D.M.D. NPI is 1043207046. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

132 CRYSTAL GATE LN
GLEN CARBON, IL
ZIP 62034-141
Phone: (618) 288-0962

The enumeration date for this NPI number is 10/4/2005 and was last updated on 4/17/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	122300000X	Dentist		019-018159	ILLINOIS	No
2	1223S0112X	Dentist	Oral and Maxillofacial Surgery	021-001642	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1420102	OTHER	ILLINOIS	UNITED CONCORDIA PROV ID
2	T95304	MEDICARE UPIN	IDAHO
3	L92149	MEDICARE PIN	ILLINOIS
4	190010592	MEDICARE PIN	ILLINOIS
5	480442	OTHER	ILLINOIS	HEALTHLINK INS PROV ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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