MEDICARE: DR. BENTON CHARLES ROTHFIELD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3839	GA

General Provider Information

NPI Number	:	1023111358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENTON CHARLES ROTHFIELD DDS

Provider Business Mailing Address
First Line	:	1155 BRICKELL BAY DR
Second Line	:	PH304
City	:	MIAMI
State	:	FL
Zip	:	33131-3243
Country	:	US
Telephone Number	:	305-379-0934
Fax Number	:	305-579-9125

Provider Business Practice Location Address
First Line	:	6805 PEMBROKE RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33023-2620
Country	:	US
Telephone Number	:	954-989-6950
Fax Number	:	954-989-6962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/09/2007

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