Provider Demographics
NPI:1972126126
Name:BOSS AND RORVIK FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:BOSS AND RORVIK FAMILY DENTAL, PLLC
Other - Org Name:BOSS & RORVIK FAMILY DENTAL AND DENTAL SLEEP THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTIN
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:RORVIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-230-4839
Mailing Address - Street 1:1504 HARCREST DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4717
Mailing Address - Country:US
Mailing Address - Phone:989-631-2900
Mailing Address - Fax:989-631-2915
Practice Address - Street 1:1504 HARCREST DR STE 2
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4717
Practice Address - Country:US
Practice Address - Phone:989-631-2900
Practice Address - Fax:989-631-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies