Provider Demographics
NPI:1245971977
Name:ROTA, KLEA (DDS)
Entity type:Individual
Prefix:
First Name:KLEA
Middle Name:
Last Name:ROTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6877 S ROLLING MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1676
Mailing Address - Country:US
Mailing Address - Phone:414-412-9274
Mailing Address - Fax:
Practice Address - Street 1:6877 S ROLLING MEADOWS CT
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1676
Practice Address - Country:US
Practice Address - Phone:414-412-9274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6000028-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist