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General NPI Number Information
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NPI Number | 1033604939
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Entity Type | Organization
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Legal Business Name | MICHIGAN ORAL REHABILITATION AND PERIODONTICS
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 1202 WALTON BLVD SUITE 208
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307
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Country | US
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Telephone | 248-703-2319
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 WALTON BLVD STE 208
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-6918
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Country | US
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Telephone | 248-963-2008
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. MICHAEL RUBEN RAMOS
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Credential | DDS, MS
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Telephone | 248-963-2008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2901019215
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License Number State | MI
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