Healthcare Provider Details

I. General information

NPI: 1447320544
Provider Name (Legal Business Name): ROBERT JOSEPH ROTELLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 45TH STREET
WEST PALM BEACH FL
33407
US

IV. Provider business mailing address

902 CLINT MOORE ROAD SUITE 138
BOCA RATON FL
33487
US

V. Phone/Fax

Practice location:
  • Phone: 561-370-1310
  • Fax: 561-845-0111
Mailing address:
  • Phone: 561-642-1008
  • Fax: 561-802-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN8969
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN8969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: