Provider Demographics
NPI:1871680678
Name:ROTELLA, DANA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:J
Last Name:ROTELLA
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 1:190 WESTBROOK RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1518
Mailing Address - Country:US
Mailing Address - Phone:860-767-1141
Mailing Address - Fax:860-767-9931
Practice Address - Street 1:190 WESTBROOK RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1518
Practice Address - Country:US
Practice Address - Phone:860-767-1141
Practice Address - Fax:860-767-9931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0230301223G0001X
CT009786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice