Provider Demographics
NPI:1235101841
Name:ROESER DENTAL ASSOCIATES PC
Entity type:Organization
Organization Name:ROESER DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROESER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-620-6800
Mailing Address - Street 1:6770 DIXIE HWY
Mailing Address - Street 2:STE 307
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-620-6800
Mailing Address - Fax:248-620-6805
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:STE 307
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-620-6800
Practice Address - Fax:248-620-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8615122300000X
MI9453122300000X
MI16742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty