MEDICARE: MICHIGAN DENTAL STUDIO ROCHESTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1194688952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN DENTAL STUDIO ROCHESTER

Provider Business Mailing Address
First Line	:	1202 WALTON BLVD STE 202
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 WALTON BLVD STE 202
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6918
Country	:	US
Telephone Number	:	248-651-8600
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER BARNES
Credential	:
Telephone Number	:	517-546-8983

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “MICHIGAN DENTAL STUDIO ROCHESTER ” Practice Location

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