Provider Demographics
NPI:1275799256
Name:ROKITA, THEODORE ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ANDREW
Last Name:ROKITA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 FRAN LIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3924
Mailing Address - Country:US
Mailing Address - Phone:219-924-7726
Mailing Address - Fax:219-924-7791
Practice Address - Street 1:9727 FRAN LIN PKWY
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3924
Practice Address - Country:US
Practice Address - Phone:219-924-7726
Practice Address - Fax:219-924-7791
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN66401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice