Healthcare Provider Details

I. General information

NPI: 1013053289
Provider Name (Legal Business Name): DANIEL ANTONIO ROVIROSA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 ROYAL PALM BLVD SUITE 102
CORAL SPRINGS FL
33065
US

IV. Provider business mailing address

8150 ROYAL PALM BLVD SUITE 102
CORAL SPRINGS FL
33065
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-8003
  • Fax: 954-989-8380
Mailing address:
  • Phone: 954-755-8003
  • Fax: 954-989-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: