MEDICARE: DR. JENNIFER LYNN ROSTOCK D.D.S.

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	1223G0001X	General Practice Dentistry	DN16579	FL

General Provider Information

NPI Number	:	1871704742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN ROSTOCK D.D.S.

Provider Business Mailing Address
First Line	:	7600 COLLINS AVE APT 408
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-2936
Country	:	US
Telephone Number	:	305-975-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 71ST ST
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-2916
Country	:	US
Telephone Number	:	305-861-7222
Fax Number	:	305-861-2300

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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