Healthcare Provider Details

I. General information

NPI: 1891769352
Provider Name (Legal Business Name): DANIEL JOSEPH ROVELSTAD D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 COLERAIN AVE
CINCINNATI OH
45239
US

IV. Provider business mailing address

8340 COLERAIN AVE
CINCINNATI OH
45239-3916
US

V. Phone/Fax

Practice location:
  • Phone: 513-385-5999
  • Fax:
Mailing address:
  • Phone: 513-385-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019-025936
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30024099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: