Provider Demographics
NPI:1326145723
Name:ROSENFELD, MICHAEL SAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SAUL
Last Name:ROSENFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5473 CENTERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3817
Mailing Address - Country:US
Mailing Address - Phone:248-855-2151
Mailing Address - Fax:
Practice Address - Street 1:38210 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1137
Practice Address - Country:US
Practice Address - Phone:586-268-1840
Practice Address - Fax:586-268-6786
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI83751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4013491Medicaid