Provider Demographics
NPI:1528008042
Name:MICHIGAN ORAL AND MAXILLOFACIAL SURGEONS, P.C.
Entity type:Organization
Organization Name:MICHIGAN ORAL AND MAXILLOFACIAL SURGEONS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SEMINARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-459-0326
Mailing Address - Street 1:2058 S STATE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4786
Mailing Address - Country:US
Mailing Address - Phone:734-769-6524
Mailing Address - Fax:734-769-6743
Practice Address - Street 1:2058 S STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4787
Practice Address - Country:US
Practice Address - Phone:734-769-5302
Practice Address - Fax:734-769-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJ801610OtherBCBS DENTAL GROUP #
MI970H17622OtherBCBS GROUP NUMBER
MI0H17622Medicare ID - Type UnspecifiedGROUP MEDICARE ID