# BAY AREA ORAL & MAXILLOFACIAL SURGERY, P.C.

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

## Provider details

- **NPI number:** 1972750826
- **Authorized official:** MRS. LUCINDA K MICHELIN (PRACTICE ADMINISTRATION)
- **Authorized official phone:** (231) 933-1220

## Contact information

- **Practice address:** 4110 COPPER RIDGE DR, SUITE 210, TRAVERSE CITY, MI 49684-6722
- **Practice address phone:** (231) 933-1220
- **Practice address fax:** (231) 933-1225
- **Mailing address:** 4110 COPPER RIDGE DR, SUITE 210, TRAVERSE CITY, MI 49684-6722
- **Mailing address phone:** (231) 933-1220
- **Mailing address fax:** (231) 933-1225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2901013774 | MI | Yes |

## Other

- **Enumeration date:** 08/22/2008
- **Last updated:** 08/22/2008