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General NPI Number Information
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NPI Number | 1932540366
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Entity Type | Organization
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Legal Business Name | NORTHVILLE ORAL & MAXIOLLOFACIAL SURGERY PLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 430 N CENTER ST
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City | NORTHVILLE
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State | MI
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Zip | 48167-1224
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Country | US
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Telephone | 248-344-4224
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Fax | 248-344-4883
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Provider Business Mailing Address
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Address Line | 430 N. CENTER ST.
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City | NORTHVILLE
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State | MI
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Zip | 48167
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Country | US
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Telephone | 248-344-4224
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Fax | 248-344-4883
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Authorized Official
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Title or Position | SURGEON
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Name | DR. ROBERT C JOHN
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Credential | D.D.S., M. D.
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Telephone | 248-969-9500
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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 | 17024
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License Number State | MI
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