Provider Demographics
NPI:1851434039
Name:DR. ELTON P. ROSENBLATT,DDS FICCMO
Entity Type:Organization
Organization Name:DR. ELTON P. ROSENBLATT,DDS FICCMO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-666-8883
Mailing Address - Street 1:8000 SW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7702
Mailing Address - Country:US
Mailing Address - Phone:305-666-8883
Mailing Address - Fax:305-669-0542
Practice Address - Street 1:8000 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7702
Practice Address - Country:US
Practice Address - Phone:305-666-8883
Practice Address - Fax:305-669-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0001029305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL83342Medicare ID - Type Unspecified