Provider Demographics
NPI:1750060174
Name:ROTHFELDT, COURTNEY (DMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:ROTHFELDT
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 1:353 CASCADE LN
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3558
Mailing Address - Country:US
Mailing Address - Phone:727-365-7270
Mailing Address - Fax:
Practice Address - Street 1:3007 RIDGELINE BLVD STE A
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-9103
Practice Address - Country:US
Practice Address - Phone:727-787-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL282781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice