Provider Demographics
NPI:1447320544
Name:ROTELLA, ROBERT JOSEPH (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:ROTELLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:902 CLINT MOORE ROAD
Mailing Address - Street 2:SUITE 138
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487
Mailing Address - Country:US
Mailing Address - Phone:561-642-1008
Mailing Address - Fax:561-802-3976
Practice Address - Street 1:1150 45TH STREET
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-370-1310
Practice Address - Fax:561-845-0111
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN89691223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry