Healthcare Provider Details

I. General information

NPI: 1619021862
Provider Name (Legal Business Name): METROPOLITAN ORAL AND MAXILLOFACIAL SURGERY, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 W BRISTOL RD
FLINT MI
48507-2923
US

IV. Provider business mailing address

5080 W BRISTOL RD
FLINT MI
48507-2923
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-5570
  • Fax: 810-733-0221
Mailing address:
  • Phone: 810-733-5570
  • Fax: 810-733-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE THOMAS GOFFAS
Title or Position: SURGEON
Credential: D.D.S., M.D., M.S.
Phone: 810-733-5570