Provider Demographics
NPI:1447350608
Name:RORVIK, KIRSTIN JENNIFER (DMD)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:JENNIFER
Last Name:RORVIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 HARCREST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4717
Mailing Address - Country:US
Mailing Address - Phone:989-631-2900
Mailing Address - Fax:989-631-2915
Practice Address - Street 1:1504 HARCREST DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4717
Practice Address - Country:US
Practice Address - Phone:989-631-2900
Practice Address - Fax:989-631-2915
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI2901019296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901019296OtherSTATE LICENSE