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General NPI Number Information
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NPI Number | 1619322526
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Entity Type | Organization
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Legal Business Name | MICHIGAN MAXILLOFACIAL SURGERY & IMPLANTS PC
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 5150 FASHION SQUARE BLVD
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City | SAGINAW
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State | MI
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Zip | 48604-9434
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Country | US
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Telephone | 989-401-6591
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Fax | 989-401-6596
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Provider Business Mailing Address
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Address Line | 5150 FASHION SQUARE BLVD
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City | SAGINAW
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State | MI
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Zip | 48604-9434
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Country | US
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Telephone | 989-401-6591
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Fax | 989-401-6596
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT C LESNESKI
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Credential | D.D.S.
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Telephone | 734-934-3420
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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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