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General NPI Number Information
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NPI Number | 1053458604
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Entity Type | Organization
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Legal Business Name | WEST SHORE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, PLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 5957 HARVEY ST
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City | NORTON SHORES
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State | MI
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Zip | 49444-9737
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Country | US
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Telephone | 231-733-1571
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Fax | 231-733-5228
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Provider Business Mailing Address
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Address Line | 5957 HARVEY ST STE 200
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City | NORTON SHORES
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State | MI
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Zip | 49444-6735
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Country | US
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Telephone | 231-733-1571
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Fax | 231-733-5228
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Authorized Official
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Title or Position | OWNER
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Name | MARK T. BURYE
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Credential | DDS
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Telephone | 231-733-1571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | B7708N
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License Number State | MI
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