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General NPI Number Information
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NPI Number | 1235101841
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Entity Type | Organization
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Legal Business Name | ROESER DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6770 DIXIE HWY STE 307
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City | CLARKSTON
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State | MI
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Zip | 48346
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Country | US
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Telephone | 248-620-6800
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Fax | 248-620-6805
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Provider Business Mailing Address
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Address Line | 6770 DIXIE HWY STE 307
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City | CLARKSTON
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State | MI
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Zip | 48346
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Country | US
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Telephone | 248-620-6800
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Fax | 248-620-6805
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. JEFFERY L ROESER
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Credential | DDS
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Telephone | 248-620-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9453
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16742
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8615
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License Number State | MI
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