Healthcare Provider Details

I. General information

NPI: 1386364446
Provider Name (Legal Business Name): DOMINIK MACIEJ ROKITA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9219 US HIGHWAY 19
PORT RICHEY FL
34668-4854
US

IV. Provider business mailing address

49 BEECHWOOD LN
BERLIN CT
06037-2044
US

V. Phone/Fax

Practice location:
  • Phone: 727-264-5300
  • Fax:
Mailing address:
  • Phone: 860-970-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: