Healthcare Provider Details

I. General information

NPI: 1275640369
Provider Name (Legal Business Name): ORAL AND FACIAL SURGEONS OF MICHIGAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 HIGHLAND RD SUITE 23
HARTLAND MI
48353-2726
US

IV. Provider business mailing address

11525 HIGHLAND RD SUITE 23
HARTLAND MI
48353-2726
US

V. Phone/Fax

Practice location:
  • Phone: 810-632-0303
  • Fax: 810-632-7305
Mailing address:
  • Phone: 810-632-0303
  • Fax: 810-632-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateMI

VIII. Authorized Official

Name: MRS. EVELYN M DAVIS
Title or Position: BILLING DEPT./ACCOUNTS
Credential:
Phone: 810-632-0303