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General NPI Number Information
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NPI Number | 1528008042
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Entity Type | Organization
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Legal Business Name | MICHIGAN ORAL AND MAXILLOFACIAL SURGEONS, P.C.
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2058 S STATE ST STE 100
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City | ANN ARBOR
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State | MI
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Zip | 48104-4787
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Country | US
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Telephone | 734-769-5302
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Fax | 734-769-8710
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Provider Business Mailing Address
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Address Line | 2058 S STATE ST SUITE 100
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City | ANN ARBOR
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State | MI
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Zip | 48104-4786
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Country | US
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Telephone | 734-769-6524
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Fax | 734-769-6743
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SARAH TYLER SEMINARA
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Credential |
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Telephone | 734-459-0326
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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 |
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License Number State |
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