Provider Demographics
NPI:1578737557
Name:ROSSOW, CHRISTOPHER MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:ROSSOW
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 1:1028 PINE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3733
Mailing Address - Country:US
Mailing Address - Phone:810-982-9801
Mailing Address - Fax:810-982-9829
Practice Address - Street 1:1101 WATER ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4421
Practice Address - Country:US
Practice Address - Phone:810-650-2785
Practice Address - Fax:810-982-9829
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist