Provider Demographics
NPI:1336879402
Name:ROSATO, OLIVIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:ROSATO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 HALBERT DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3693
Mailing Address - Country:US
Mailing Address - Phone:727-458-0702
Mailing Address - Fax:
Practice Address - Street 1:2202 DUCK SLOUGH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5071
Practice Address - Country:US
Practice Address - Phone:727-375-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist