Basic Information
| Provider Information | |||||||||
| NPI: | 1447320544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROTELLA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 CLINT MOORE ROAD | ||||||||
| Address2: | SUITE 138 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616421008 | ||||||||
| FaxNumber: | 5618023976 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 45TH STREET | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613701310 | ||||||||
| FaxNumber: | 5618450111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | DN8969 | FL | N | Dental Providers | Dentist | Pediatric Dentistry | 122300000X | DN8969 | FL | Y | Dental Providers | Dentist |
No ID Information.