=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265955082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAMAT ORAL & MAXILLOFACIAL SURGERY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2017
-----------------------------------------------------
Last Update Date | 09/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51685 VAN DYKE AVE
-----------------------------------------------------
City | SHELBY TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-924-2038
-----------------------------------------------------
Fax | 586-323-1644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51685 VAN DYKE AVE
-----------------------------------------------------
City | SHELBY TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48316-4449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-924-2038
-----------------------------------------------------
Fax | 586-323-1644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. KATIE WHITE
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 586-924-2038
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------