Provider Demographics
NPI:1245863182
Name:CHRISTOPHER M ROSSOW DDS PC
Entity type:Organization
Organization Name:CHRISTOPHER M ROSSOW DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSSOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-982-9801
Mailing Address - Street 1:1101 WATER ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-4421
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:810-982-9801
Practice Address - Fax:810-982-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental