Healthcare Provider Details

I. General information

NPI: 1790613016
Provider Name (Legal Business Name): CYNTHIA ROUSSERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 RENAISSANCE COMMONS BLVD APT 1118
BOYNTON BEACH FL
33426-7204
US

IV. Provider business mailing address

1690 RENAISSANCE COMMONS BLVD
BOYNTON BEACH FL
33426-7203
US

V. Phone/Fax

Practice location:
  • Phone: 656-231-1176
  • Fax:
Mailing address:
  • Phone: 656-231-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: