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General NPI Number Information
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NPI Number | 1598255044
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Entity Type | Organization
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Legal Business Name | BIRMINGHAM ORAL & MAXILLOFACIAL SURGERY, PLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 555 S OLD WOODWARD AVE STE 777
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City | BIRMINGHAM
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State | MI
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Zip | 48009
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Country | US
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Telephone | 248-647-4700
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Fax | 248-647-4730
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Provider Business Mailing Address
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Address Line | 555 S OLD WOODWARD AVE STE 777
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6618
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Country | US
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Telephone | 248-647-4700
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Fax | 248-647-4730
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Authorized Official
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Title or Position | BILLER
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Name | BEVERLY MCNAUGHTON
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Credential |
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Telephone | 486-474-7002
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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 | 2901012981
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License Number State | MI
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