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Organization
GREAT LAKES ORAL AND MAXILLOFACIAL SURGERY P.C.
Active
Organization
GREAT LAKES ORAL AND MAXILLOFACIAL SURGERY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT SCOTT SHEPERD DDS (CEO/PRESIDENT)
(231) 487-1020
Entity
Organization
Contact information
Practice address
2325 SUMMIT PARK DR STE D, PETOSKEY, MI 49770-8774
(231) 487-1020
Mailing address
2325 SUMMIT PARK DR STE D, PETOSKEY, MI 49770-8774
(231) 487-1020
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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