# ORAL AND MAXILLOFACIAL SURGERY SERVICES, PLC

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

## Provider details

- **NPI number:** 1548283559
- **Authorized official:** DR. KIM L ERICKSON D.D.S. (OWNER)
- **Authorized official phone:** (616) 977-5000

## Contact information

- **Practice address:** 4500 CASCADE RD SE, SUITE \#208, GRAND RAPIDS, MI 49546-3665
- **Practice address phone:** (616) 977-5000
- **Practice address fax:** (616) 977-0020
- **Mailing address:** 4500 CASCADE RD SE, SUITE \#208, GRAND RAPIDS, MI 49546-3665
- **Mailing address phone:** (616) 977-5000
- **Mailing address fax:** (616) 977-0020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | KE011553 | MI | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | KE011553 | MI | — |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | KE011553 | MI | Yes |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 09/11/2025