Provider Demographics
NPI:1518538123
Name:FORD, ROXANNE CHRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:CHRISTINE
Last Name:FORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 ISLAND HWY
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-8310
Mailing Address - Country:US
Mailing Address - Phone:517-862-7625
Mailing Address - Fax:
Practice Address - Street 1:2500 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2158
Practice Address - Country:US
Practice Address - Phone:517-694-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist