Provider Demographics
NPI:1821152364
Name:ROSSITCH, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ROSSITCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3698 LARGENT WAY NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5923
Mailing Address - Country:US
Mailing Address - Phone:770-420-6565
Mailing Address - Fax:770-420-6570
Practice Address - Street 1:3698 LARGENT WAY NW
Practice Address - Street 2:SUITE 201
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5923
Practice Address - Country:US
Practice Address - Phone:770-420-6565
Practice Address - Fax:770-420-6570
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0129621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN012962OtherLICENSE
BR8870342OtherDEA
260568973AMedicare ID - Type Unspecified