Healthcare Provider Details

I. General information

NPI: 1932314895
Provider Name (Legal Business Name): JEFF STUART ROTHENBERG D.M.D. M.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18851 N.E. 29TH AVENUE, SUITE 300
AVENTURA FL
33180
US

IV. Provider business mailing address

18851 N.E. 29TH AVENUE, SUITE 300
AVENTURA FL
33180
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-1415
  • Fax: 305-933-1920
Mailing address:
  • Phone: 305-933-1415
  • Fax: 305-933-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN15735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: