Healthcare Provider Details

I. General information

NPI: 1912951948
Provider Name (Legal Business Name): ROSA ROLDAN DMD,MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

1640 SW 4TH AVE
BOCA RATON FL
33432-7231
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-8538
  • Fax:
Mailing address:
  • Phone: 786-371-1396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN17387
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: