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General NPI Number Information
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NPI Number | 1902777980
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Entity Type | Organization
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Legal Business Name | RVDAK ENTERPRISES
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 10845 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-8012
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Country | US
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Telephone | 813-378-3748
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Fax |
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Provider Business Mailing Address
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Address Line | 330 E HIGHLAND DR
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City | LAKELAND
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State | FL
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Zip | 33813-1727
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Country | US
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Telephone | 863-640-0555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID ROSEN
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Credential | DMD
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Telephone | 863-640-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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