# GRAND TRAVERSE ORAL SURGERY, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003095605
- **Authorized official:** SUSAN J. SCHLUETER (OFFICE MANAGER)
- **Authorized official phone:** (231) 946-3512

## Contact information

- **Practice address:** 12776 S WEST BAY SHORE DR, TRAVERSE CITY, MI 49684-5451
- **Practice address phone:** (231) 946-3512
- **Practice address fax:** (231) 946-1908
- **Mailing address:** 12776 S WEST BAY SHORE DR, TRAVERSE CITY, MI 49684-5451
- **Mailing address phone:** (231) 946-3512
- **Mailing address fax:** (231) 946-1908

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 10/31/2007
- **Last updated:** 03/19/2008