Healthcare Provider Details

I. General information

NPI: 1245863182
Provider Name (Legal Business Name): CHRISTOPHER M ROSSOW DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WATER ST
PORT HURON MI
48060-4421
US

IV. Provider business mailing address

1101 WATER ST
PORT HURON MI
48060-4421
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-9801
  • Fax: 810-982-9829
Mailing address:
  • Phone: 810-982-9801
  • Fax: 810-982-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER M ROSSOW
Title or Position: PRESIDENT
Credential: DDS
Phone: 810-982-9801