Healthcare Provider Details

I. General information

NPI: 1396521688
Provider Name (Legal Business Name): EIGHT OAKS PROFESSIONAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W BIG BEAVER SUITE 110
TROY MI
48084
US

IV. Provider business mailing address

1500 W BIG BEAVER SUITE 110
TROY MI
48084
US

V. Phone/Fax

Practice location:
  • Phone: 248-665-8769
  • Fax:
Mailing address:
  • Phone: 248-665-8769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT C JOHN
Title or Position: OWNER
Credential: MD, DDS
Phone: 248-665-8769