Provider Demographics
NPI:1306406178
Name:ROTELLA, ZOE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:MARIE
Last Name:ROTELLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11603 MANATEE BAY LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8386
Mailing Address - Country:US
Mailing Address - Phone:561-309-9185
Mailing Address - Fax:
Practice Address - Street 1:3612 AUSTIN DAVIS AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7401
Practice Address - Country:US
Practice Address - Phone:850-877-0215
Practice Address - Fax:850-329-2642
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL240611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice