Provider Demographics
NPI:1386364446
Name:ROKITA, DOMINIK MACIEJ (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMINIK
Middle Name:MACIEJ
Last Name:ROKITA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2044
Mailing Address - Country:US
Mailing Address - Phone:860-970-8827
Mailing Address - Fax:
Practice Address - Street 1:9219 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4854
Practice Address - Country:US
Practice Address - Phone:727-264-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN274011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice