Healthcare Provider Details

I. General information

NPI: 1932388691
Provider Name (Legal Business Name): MICHAEL JAY ROVNER DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 MORNING STAR CT.
PLEASANT HILL IA
50327-2230
US

IV. Provider business mailing address

5890 MORNING STAR CT.
PLEASANT HILL IA
50327-2230
US

V. Phone/Fax

Practice location:
  • Phone: 515-266-2154
  • Fax: 515-266-8065
Mailing address:
  • Phone: 515-266-2154
  • Fax: 515-266-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6170
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: