Provider Demographics
NPI:1760777247
Name:MICHAEL D ROSVALL, DDS MS, INC
Entity Type:Organization
Organization Name:MICHAEL D ROSVALL, DDS MS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSVALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:614-404-9429
Mailing Address - Street 1:13178 S 5600 W
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6728
Mailing Address - Country:US
Mailing Address - Phone:801-253-6645
Mailing Address - Fax:801-253-0735
Practice Address - Street 1:13178 S 5600 W
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6728
Practice Address - Country:US
Practice Address - Phone:801-253-6645
Practice Address - Fax:801-253-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6834576-9921261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental