MEDICARE: MICHIGAN ORAL REHABILITATION AND PERIODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	2901019215	MI

General Provider Information

NPI Number	:	1033604939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN ORAL REHABILITATION AND PERIODONTICS

Provider Business Mailing Address
First Line	:	1202 WALTON BLVD STE 208
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6918
Country	:	US
Telephone Number	:	248-963-2008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 WALTON BLVD
Second Line	:	SUITE 208
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307
Country	:	US
Telephone Number	:	248-703-2319
Fax Number	:

Authorized Official
Title or Position	:	PERIODONTIST
Name	:	DR. MICHAEL RUBEN RAMOS
Credential	:	DDS, MS
Telephone Number	:	248-963-2008

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	10/30/2018

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