Healthcare Provider Details

I. General information

NPI: 1881797983
Provider Name (Legal Business Name): ORAL SURGERY ASSOCIATES OF LANSING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5238 W ST JOE HWY SUITE 2
LANSING MI
48917-4085
US

IV. Provider business mailing address

4201 OKEMOS RD
OKEMOS MI
48864-3200
US

V. Phone/Fax

Practice location:
  • Phone: 517-323-1000
  • Fax: 517-886-5566
Mailing address:
  • Phone: 517-349-8383
  • Fax: 517-349-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JEFFREY E PERSICO
Title or Position: OWNER
Credential: DMD
Phone: 517-349-8383