MEDICARE: BAY AREA ORAL & MAXILLOFACIAL SURGERY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2901013774	MI

General Provider Information

NPI Number	:	1972750826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA ORAL & MAXILLOFACIAL SURGERY, P.C.

Provider Business Mailing Address
First Line	:	4110 COPPER RIDGE DR
Second Line	:	SUITE 210
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6722
Country	:	US
Telephone Number	:	231-933-1220
Fax Number	:	231-933-1225

Provider Business Practice Location Address
First Line	:	4110 COPPER RIDGE DR
Second Line	:	SUITE 210
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6722
Country	:	US
Telephone Number	:	231-933-1220
Fax Number	:	231-933-1225

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATION
Name	:	MRS. LUCINDA K MICHELIN
Credential	:
Telephone Number	:	231-933-1220

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	08/22/2008

Similar Medicare Providers

1356563654 — THE CENTER FOR PLASTIC SURGERY OF NORTHERN MICHIGAN
Practice Location Address:

4110 COPPER RIDGE DR , SUITE 242
TRAVERSE CITY, MI
49684-6722

Practice Phone: 231-929-7700
Practice Fax:

1306003819 — DR. CHRISTOPHER CARSON JEFFRIES M.D.
Practice Location Address:

4110 COPPER RIDGE DR , SUITE 242
TRAVERSE CITY, MI
49684-6722

Practice Phone: 231-929-7700
Practice Fax: 231-929-7709

1255666970 — DR. ROBERT J LYONS D.C.
Practice Location Address:

4110 COPPER RIDGE DR , STE. 210
TRAVERSE CITY, MI
49684-6722

Practice Phone: 231-943-2229
Practice Fax: 231-943-2231

1598712440 — RHETT MELVIN BURGENER OD
Practice Location Address:

1923 MCCULLOCH BLVD #102
LAKE HAVASU CITY, AZ
86403-6722

Practice Phone: 928-854-3555
Practice Fax: 928-854-4544

1629269154 — MR. JERMAINE QUENTIN LOVE P.T.
Practice Location Address:

12004 CAMELOT PL
OKLAHOMA CITY, OK
73120-6722

Practice Phone: 405-812-2082
Practice Fax:

1891073185 — CLAUDIA H LOW APRN, ACNS-BC
Practice Location Address:

301 12TH ST SE
WATFORD CITY, ND
58854-6722

Practice Phone: 701-842-6400
Practice Fax: 701-842-6403

Directions to “BAY AREA ORAL & MAXILLOFACIAL SURGERY, P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.