1518538123 NPI number — DR. ROXANNE CHRISTINE FORD DDS

Table of content: DR. ROXANNE CHRISTINE FORD DDS (NPI 1518538123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518538123 NPI number — DR. ROXANNE CHRISTINE FORD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
ROXANNE
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518538123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9235 ISLAND HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATON RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48827-8310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-862-7625
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 W ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48854-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-676-3711
Provider Business Practice Location Address Fax Number:
517-676-4811
Provider Enumeration Date:
07/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901600933 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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