# CEDARROCK DENTAL CARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972571362
- **Authorized official:** DR. RICHARD L JERUZAL DDS (PRESIDENT)
- **Authorized official phone:** (616) 866-4461

## Contact information

- **Practice address:** 4655 14 MILE RD NE, ROCKFORD, MI 49341
- **Practice address phone:** (616) 866-4461
- **Practice address fax:** (616) 696-3420
- **Mailing address:** 4655 14 MILE RD NE, ROCKFORD, MI 49341
- **Mailing address phone:** (616) 866-4461
- **Mailing address fax:** (616) 696-3420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 10232 | MI | Yes |

## Other

- **Enumeration date:** 03/10/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4051090 | — | MI |