Provider Demographics
NPI:1417003278
Name:ROUFF, MICHAEL IRWIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IRWIN
Last Name:ROUFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 JESSUP ROAD
Mailing Address - Street 2:SUITE 805
Mailing Address - City:THOROFARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08086
Mailing Address - Country:US
Mailing Address - Phone:856-845-4390
Mailing Address - Fax:856-845-5342
Practice Address - Street 1:800 JESSUP ROAD
Practice Address - Street 2:SUITE 805
Practice Address - City:THOROFARE
Practice Address - State:NJ
Practice Address - Zip Code:08086
Practice Address - Country:US
Practice Address - Phone:856-845-4390
Practice Address - Fax:856-845-5342
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016543001223G0001X
PADS026259L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice