GREAT LAKES ORAL SURGERY AND IMPLANTS P.C. NPI 1902993819

NPI Information

NPI: 1902993819
Provider Name: GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C.
Classification: Dentist - 1223S0112X
Specialization: Oral and Maxillofacial Surgery
Entity Type: Organization
Doing Business As: GREATER MICHIGAN ORAL SURGEONS & DENTAL IMPLANT CENTER
Address: 5417 GATEWAY CTR
FLINT, MI
ZIP 48507
Phone: (810) 424-0705

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NPI Details

GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C. is an oral and maxillofacial surgery dentist in Flint, 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. GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C. NPI is 1902993819. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Greater Michigan Oral Surgeons & Dental Implant Center.

The provider's business location address is:

5417 GATEWAY CTR
FLINT, MI
ZIP 48507-980
Phone: (810) 424-0705
Fax: (810) 424-0750

The provider's authorized official is Samantha A Kern .
The authorized official title is Credentialing & Billing and has the following contact phone number (810) 424-0705.

The enumeration date for this NPI number is 10/10/2006 and was last updated on 8/28/2024.

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
1	1223S0112X	Dentist	Oral and Maxillofacial Surgery			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2594587	MEDICAID	MICHIGAN
2	9752562480	OTHER	MICHIGAN	BLUE CROSS BLUE SHIELD
3	4045904	MEDICAID	MICHIGAN
4	975256759	OTHER	MICHIGAN	BLUE CROSS BLUE SHIELD
5	4417670	MEDICAID	MICHIGAN
6	195256547	OTHER	MICHIGAN	BLUE CROSS BLUE SHIELD

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: 3/30/2025

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