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General NPI Number Information
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NPI Number | 1518859446
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Entity Type | Organization
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Legal Business Name | ST. CLAIR ORAL AND MAXILLOFACIAL SURGERY PLLC
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 36610 HERITAGE DR
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City | RICHMOND
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State | MI
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Zip | 48062-1937
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Country | US
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Telephone | 586-727-6800
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Fax | 586-727-6880
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Provider Business Mailing Address
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Address Line | 36610 HERITAGE DR
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City | RICHMOND
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State | MI
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Zip | 48062-1937
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Country | US
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Telephone |
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Fax | 586-727-6880
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAREN R FAGE
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Credential |
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Telephone | 586-634-6824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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