Healthcare Provider Details

I. General information

NPI: 1093913626
Provider Name (Legal Business Name): ROSEANNA P NOORDHOEK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 HIGHLAND RD SUITE 11
HARTLAND MI
48353-2726
US

IV. Provider business mailing address

11525 HIGHLAND RD SUITE 11
HARTLAND MI
48353-2726
US

V. Phone/Fax

Practice location:
  • Phone: 810-632-4545
  • Fax: 810-632-9397
Mailing address:
  • Phone: 810-632-4545
  • Fax: 810-632-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901021728
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS038591
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: