Healthcare Provider Details

I. General information

NPI: 1467663294
Provider Name (Legal Business Name): ROSOLINO VINCENT SCLAFANI DDS,MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 E JEFFERSON AVE SUITE 2B
DETROIT MI
48214-3704
US

IV. Provider business mailing address

37251 WILLOW LN
CLINTON TOWNSHIP MI
48036-3667
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax: 313-499-4908
Mailing address:
  • Phone: 586-362-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901019257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: