Individual
DR. EZZARD ROLLE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 HAVEN AVE, NEW YORK, NY 10032-2645
(212) 342-0107
Mailing address
100 HAVEN AVE, NEW YORK, NY 10032-2645
(212) 342-0107
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
059409
NY
1223G0001X
General Practice Dentistry
16319
MD
Other
Enumeration date
03/07/2017
Last updated
01/17/2022
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