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General NPI Number Information
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NPI Number | 1760777247
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Entity Type | Organization
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Legal Business Name | MICHAEL D ROSVALL, DDS MS, INC
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 13178 S 5600 W
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City | HERRIMAN
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State | UT
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Zip | 84096-6728
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Country | US
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Telephone | 801-253-6645
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Fax | 801-253-0735
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Provider Business Mailing Address
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Address Line | 13178 S 5600 W
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City | HERRIMAN
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State | UT
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Zip | 84096-6728
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Country | US
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Telephone | 801-253-6645
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Fax | 801-253-0735
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL D ROSVALL
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Credential | DDS, MS
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Telephone | 614-404-9429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6834576-9921
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License Number State | UT
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