# RENAISSANCE ORAL SURGERY PC

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

## Provider details

- **NPI number:** 1235325499
- **Authorized official:** MR. HENRY BRYAN DDS (PRESIDENT)
- **Authorized official phone:** (586) 778-2100

## Contact information

- **Practice address:** 20805 E 12 MILE RD, STE 110, ROSEVILLE, MI 48066
- **Practice address phone:** (586) 778-2100
- **Practice address fax:** (586) 778-2422
- **Mailing address:** 20805 E 12 MILE RD, STE 110, ROSEVILLE, MI 48066
- **Mailing address phone:** (586) 778-2100
- **Mailing address fax:** (586) 778-2422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |
| 2082S0099X | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician | — | NULL | — |
| 2082S0099X | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 09/21/2007
- **Last updated:** 10/01/2013