Healthcare Provider Details

I. General information

NPI: 1013409515
Provider Name (Legal Business Name): STEFHANY G DUQUE ROSAS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WINTER GARDEN VINELAND RD
WINTER GARDEN FL
34787-5483
US

IV. Provider business mailing address

4961 S ORANGE AVE
ORLANDO FL
32806-6957
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-1296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: