Provider Demographics
NPI:1215997242
Name:ROSADO, ITZA MARIE (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:ITZA
Middle Name:MARIE
Last Name:ROSADO
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12781 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2906
Mailing Address - Country:US
Mailing Address - Phone:954-433-2225
Mailing Address - Fax:954-433-4421
Practice Address - Street 1:16223 MIRAMAR PARKWAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4572
Practice Address - Country:US
Practice Address - Phone:954-433-2225
Practice Address - Fax:954-433-4421
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN153231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice