Healthcare Provider Details

I. General information

NPI: 1235230145
Provider Name (Legal Business Name): ROSE ANN JEANETTE BARTNIK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47100 SCHOENHERR RD STE. A
SHELBY TOWNSHIP MI
48315-4716
US

IV. Provider business mailing address

683 PLUM RIDGE DR
ROCHESTER HILLS MI
48309-1021
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-8338
  • Fax: 586-566-8339
Mailing address:
  • Phone: 248-370-9884
  • Fax: 248-370-9884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901013539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: