Healthcare Provider Details

I. General information

NPI: 1972126126
Provider Name (Legal Business Name): BOSS AND RORVIK FAMILY DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 HARCREST DR STE 2
MIDLAND MI
48640-4717
US

IV. Provider business mailing address

1504 HARCREST DR STE 2
MIDLAND MI
48640-4717
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-2900
  • Fax: 989-631-2915
Mailing address:
  • Phone: 989-631-2900
  • Fax: 989-631-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRSTIN JENNIFER RORVIK
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 617-230-4839