Provider Demographics
NPI:1386702827
Name:DEFELICE, JANICE ROUSELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:ROUSELLE
Last Name:DEFELICE
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 1:250 180TH DR
Mailing Address - Street 2:304
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2796
Mailing Address - Country:US
Mailing Address - Phone:305-542-6644
Mailing Address - Fax:
Practice Address - Street 1:226 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5436
Practice Address - Country:US
Practice Address - Phone:954-454-3883
Practice Address - Fax:954-454-1901
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLELTOQCMedicaid