Provider Demographics
NPI:1437399607
Name:ROTHBERG, MELANIE RAE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:RAE
Last Name:ROTHBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10188 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3913
Mailing Address - Country:US
Mailing Address - Phone:954-752-7651
Mailing Address - Fax:954-755-1572
Practice Address - Street 1:10188 NW 31ST ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3913
Practice Address - Country:US
Practice Address - Phone:954-752-7651
Practice Address - Fax:954-755-1572
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry