ADVANCED ORAL SURGERY PLLC NPI 1508324732

NPI Information

  • NPI: 1508324732
  • Provider Name: ADVANCED ORAL SURGERY, PLLC
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • Address: 3855 BURTON ST SE STE B
    GRAND RAPIDS, MI
    ZIP 49546
  • Phone: (616) 369-0360

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NPI Details

ADVANCED ORAL SURGERY, PLLC is an oral and maxillofacial surgery dentist in Grand Rapids, MI. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. ADVANCED ORAL SURGERY, PLLC NPI is 1508324732. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3855 BURTON ST SE STE B
GRAND RAPIDS, MI
ZIP 49546-147
Phone: (616) 369-0360
Fax: (616) 369-0361

The provider's authorized official is Mark Leonard Jesin .
The authorized official title is Manager and has the following contact phone number (616) 369-0360.

The enumeration date for this NPI number is 3/6/2019 and was last updated on 3/6/2019.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryYes

What is NPI?

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This page was last updated on: 11/21/2025

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