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General NPI Number Information
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NPI Number | 1619964715
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Entity Type | Organization
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Legal Business Name | MIDLAND ORAL & MAXILLOFACIAL SURGERY P.C.
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 6112 MERLIN CT
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City | MIDLAND
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State | MI
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Zip | 48640
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Country | US
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Telephone | 989-839-9979
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Fax | 989-839-9553
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Provider Business Mailing Address
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Address Line | 6112 MERLIN CT
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City | MIDLAND
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State | MI
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Zip | 48640-7358
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Country | US
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Telephone | 989-839-9979
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Fax | 989-839-9553
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Authorized Official
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Title or Position | FINANCIAL DEPT
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Name | SHIANNE BOWERS
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Credential |
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Telephone | 989-839-9979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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