Healthcare Provider Details

I. General information

NPI: 1033392311
Provider Name (Legal Business Name): JAMES T ROGOZINSKI CEDAR CREEK FAMILY DENTAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5216 WOODVILLE RD
NORTHWOOD OH
43619-2206
US

IV. Provider business mailing address

5216 WOODVILLE RD
NORTHWOOD OH
43619-2206
US

V. Phone/Fax

Practice location:
  • Phone: 419-693-0441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21509
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES T JROGOZINSKI
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 419-693-0441