Healthcare Provider Details

I. General information

NPI: 1518017789
Provider Name (Legal Business Name): ESPECIALLY FOR KIDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25811 W 12 MILE RD SUITE 202
SOUTHFIELD MI
48034
US

IV. Provider business mailing address

25811 W. 12 MILE RD SUITE 202
SOUTHFIELD MI
48034
US

V. Phone/Fax

Practice location:
  • Phone: 248-559-5554
  • Fax: 248-559-3114
Mailing address:
  • Phone: 248-559-5554
  • Fax: 248-559-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13198
License Number StateMI

VIII. Authorized Official

Name: DR. ANGELA M ROGERS
Title or Position: PEDIATRIC DENTIST
Credential: DMD,MS
Phone: 248-559-5554