Provider Demographics
NPI:1427835792
Name:BLOOMFIELD ORAL & MAXILLOFACIAL SURGERY PLLC
Entity type:Organization
Organization Name:BLOOMFIELD ORAL & MAXILLOFACIAL SURGERY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORGACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-877-1126
Mailing Address - Street 1:33 BLOOMFIELD HILLS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2945
Mailing Address - Country:US
Mailing Address - Phone:248-341-8477
Mailing Address - Fax:248-341-8479
Practice Address - Street 1:33 BLOOMFIELD HILLS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2945
Practice Address - Country:US
Practice Address - Phone:248-877-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty