# UPPER MICHIGAN ORAL & MAXILLOFACIAL SURGERY PC

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

## Provider details

- **NPI number:** 1316110778
- **Authorized official:** RICHARD STANCHINA (PRESIDENT)
- **Authorized official phone:** (906) 228-7173

## Contact information

- **Practice address:** 1250 WILSON ST, SUITE 101, MARQUETTE, MI 49855-4454
- **Practice address phone:** (906) 228-7173
- **Practice address fax:** (906) 228-2916
- **Mailing address:** 1250 WILSON ST, SUITE 101, MARQUETTE, MI 49855-4454
- **Mailing address phone:** (906) 228-7173
- **Mailing address fax:** (906) 228-2916

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | J14145 | MI | Yes |

## Other

- **Enumeration date:** 04/08/2008
- **Last updated:** 11/01/2016