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General NPI Number Information
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NPI Number | 1619021862
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Entity Type | Organization
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Legal Business Name | METROPOLITAN ORAL AND MAXILLOFACIAL SURGERY, P.L.L.C.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 5080 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-2923
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Country | US
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Telephone | 810-733-5570
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Fax | 810-733-0221
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Provider Business Mailing Address
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Address Line | 5080 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-2923
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Country | US
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Telephone | 810-733-5570
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Fax | 810-733-0221
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Authorized Official
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Title or Position | SURGEON
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Name | DR. GEORGE THOMAS GOFFAS
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Credential | D.D.S., M.D., M.S.
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Telephone | 810-733-5570
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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 | MI
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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