MEDICARE: DR. KRISTINA ROBERTI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN29211	FL

General Provider Information

NPI Number	:	1134965072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA ROBERTI DMD

Provider Business Mailing Address
First Line	:	451 NW 87TH LN APT 102
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-6540
Country	:	US
Telephone Number	:	352-410-2701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 E COMMERCIAL BLVD STE 208
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-3754
Country	:	US
Telephone Number	:	855-381-6001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2024
Last Update Date	:	07/01/2024

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