Provider Demographics
NPI:1588732556
Name:ROLFE FAMILY & COSMETIC DENTISTRY
Entity type:Organization
Organization Name:ROLFE FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-537-9777
Mailing Address - Street 1:16772 W BELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9702
Mailing Address - Country:US
Mailing Address - Phone:623-537-9777
Mailing Address - Fax:623-537-9888
Practice Address - Street 1:16772 W BELL RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9702
Practice Address - Country:US
Practice Address - Phone:623-537-9777
Practice Address - Fax:623-537-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD58411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty