Healthcare Provider Details

I. General information

NPI: 1982937454
Provider Name (Legal Business Name): MICHIGAN CENTER FOR ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22150 ALLEN RD SUITE 1
WOODHAVEN MI
48183-2271
US

IV. Provider business mailing address

22150 ALLEN RD SUITE 1
WOODHAVEN MI
48183-2271
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-1520
  • Fax: 734-675-2118
Mailing address:
  • Phone: 734-675-1520
  • Fax: 734-675-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901017976
License Number StateMI

VIII. Authorized Official

Name: DR. DEXTER KURT FLEMMING
Title or Position: OWNER
Credential: DDS MS
Phone: 734-675-1520