Healthcare Provider Details

I. General information

NPI: 1518827252
Provider Name (Legal Business Name): OXFORD LAKES PERIODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S LAPEER RD
OXFORD MI
48371-5041
US

IV. Provider business mailing address

950 S LAPEER RD
OXFORD MI
48371-5041
US

V. Phone/Fax

Practice location:
  • Phone: 248-313-8882
  • Fax:
Mailing address:
  • Phone: 248-313-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: RITA SHAOONI
Title or Position: DENTAL BILLER
Credential:
Phone: 586-925-3154