Great Lakes Oral Surgery And Implants, P.c.

NPI 1902993819

Information of Great Lakes Oral Surgery And Implants, P.c.

The NPI 1902993819 is an Organization type. NPI No 1902993819 belongs to Great Lakes Oral Surgery And Implants, P.c.. Great Lakes Oral Surgery And Implants, P.c. specializes in Oral and Maxillofacial Surgery. is practising at 5417gateway Centre Blvd., Flint, Michigan 48507. You can also contact him via phone number (810) 424-0705.

Practice address located

  • 5417gateway Centre Blvd.
  • Flint, Michigan 48507
  • (810) 424-0705
  • (810) 424-0705

Mailling address located

  • 5417 Gateway Centre Blvd.
  • Flint, Michigan 48507
  • (810) 424-0705
  • (810) 424-0750
Great Lakes Oral Surgery And Implants, P.c. is PECOS enrolled.
NPI No 1902993819
Primary Taxonomy
Authorized Official
Specialty of the provider
PrimaryTaxonomy CodeClassificationLicense NumberLicense State
Yes1223S0112XOral and Maxillofacial Surgeryn/an/a
Identifier for this provider
StateIdentifierTypeIssuer
MI195256547OtherBLUE CROSS BLUE SHIELD
MI2594587Medicaidn/a
MI4045904Medicaidn/a
MI4417670Medicaidn/a
MI9752562480OtherBLUE CROSS BLUE SHIELD
MI975256759OtherBLUE CROSS BLUE SHIELD
MIOP30330Medicare UPINn/a
n/aT82821Medicare UPINn/a
n/aU18504Medicare UPINn/a
n/aU89030Medicare UPINn/a
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