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ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WESTERN MICHIGAN PLC NPI 1598772626


NPI Information

NPI: 1598772626
Provider Name: ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WESTERN MICHIGAN PLC
Classification: Oral & Maxillofacial Surgery - 204E00000X
Entity Type: Organization
Address:
2140 LAKE MICHIGAN DR NW
GRAND RAPIDS, MI
ZIP 49504
Phone: (616) 791-9600
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ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WESTERN MICHIGAN PLC is an oral maxillofacial surgery in Grand Rapids, MI. The provider is oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WESTERN MICHIGAN PLC NPI is 1598772626. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2140 LAKE MICHIGAN DR NW
GRAND RAPIDS, MI
ZIP 49504-785
Phone: (616) 791-9600
Fax: (616) 791-9603

The provider's authorized official is J Mark Domin .
The authorized official title is Member and has the following contact phone number (616) 791-9600.

The enumeration date for this NPI number is 8/2/2006 and was last updated on 4/12/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1204E00000XOral & Maxillofacial SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1970D111530OTHERBCBSM BCN/CHOICE
20N13750OTHERMICHIGANMEDICARE GROUP NUMBER
3CC0861OTHERMEDICARE RAILROAD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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