Cedarrock Dental Care PC

Primary specialty

DentistTaxonomy code 122300000X

License

10232 Issued in MI

Legal business name

CEDARROCK DENTAL CARE PC

Practice address

4655 14 Mile Rd NE
Rockford, MI 49341

Phone

(616) 866-4461

Fax

(616) 696-3420

NPI assigned

Mar 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard L Jeruzal, DDS

Title

President

Phone

(616) 866-4461

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972571362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 14 MILE RD NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-866-4461",
            "fax_number": "616-696-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 14 MILE RD NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-866-4461",
            "fax_number": "616-696-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDARROCK DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JERUZAL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-866-4461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "10232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4051090",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deena Iris Cantu Plews, LIMITED LICENSED PSY
• Eileen Diane Carmolli, RBT
• John Carr, M.D.
• Keleigh Caruso
• Amy Casady
• Chad J. Jackson, OD, PLLC
• Champion Chiropractic Clinic, PLC
• Dereck Fitzgerald Chavis
• Child and Family Wellness Consultants LLC
• Rebekah M Chino, LLMSW

• Dentist in Rockford, MI
• Providers in Rockford, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.