Healthcare Provider Details

I. General information

NPI: 1245942697
Provider Name (Legal Business Name): ROCHESTER ENDODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 W TIENKEN RD STE C
ROCHESTER HILLS MI
48306-4475
US

IV. Provider business mailing address

480 W TIENKEN RD STE C
ROCHESTER HILLS MI
48306-4475
US

V. Phone/Fax

Practice location:
  • Phone: 248-941-0024
  • Fax:
Mailing address:
  • Phone: 248-941-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES P THOMAS JR.
Title or Position: OWNER
Credential: DDS, MS
Phone: 248-941-0024