Provider Demographics
NPI:1417007501
Name:ROLFE, DOUGLAS A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:ROLFE
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 1:333 CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5824
Mailing Address - Country:US
Mailing Address - Phone:561-395-4500
Mailing Address - Fax:561-361-8854
Practice Address - Street 1:333 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5824
Practice Address - Country:US
Practice Address - Phone:561-395-4500
Practice Address - Fax:561-361-8854
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice