Provider Demographics
NPI:1104968155
Name:RISI ROTTER, ASTRID M (DMD)
Entity type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:M
Last Name:RISI ROTTER
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 1:12102 SW 102ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2657
Mailing Address - Country:US
Mailing Address - Phone:305-205-8090
Mailing Address - Fax:
Practice Address - Street 1:12102 SW 102ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2657
Practice Address - Country:US
Practice Address - Phone:305-205-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN138521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice