Healthcare Provider Details

I. General information

NPI: 1356390306
Provider Name (Legal Business Name): MICHAEL G ROFE D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 ROCHESTER RD
TROY MI
48085-4951
US

IV. Provider business mailing address

4770 ROCHESTER RD
TROY MI
48085-4951
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-3518
  • Fax:
Mailing address:
  • Phone: 248-528-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901010567
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: