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General NPI Number Information
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NPI Number | 1881920619
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Entity Type | Organization
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Legal Business Name | BLISS ORAL & FACIAL SURGERY
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 2201 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2314
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Country | US
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Telephone | 734-282-4224
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Fax | 724-282-7361
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Provider Business Mailing Address
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Address Line | 2201 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2314
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Country | US
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Telephone | 734-282-4224
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Fax | 724-282-7361
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER TIMOTHY BLISS
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Credential | DMD
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Telephone | 734-282-4224
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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 | D166720
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License Number State | MI
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