Organization
BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC
Active
Parent organization
BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC
Other names
Great Oaks Periodontics & Dental Implants
Organization subpart
Yes
Provider details
NPI number
Legal business name
BREAKWATER ORAL AND MAXILLOFACIAL SURGERY PLLC
Authorized official
JENN HERITAGE (CREDENTIALING MANAGER)
(402) 805-4516
Entity
Organization
Contact information
Practice address
1000 W UNIVERSITY DR STE 207, ROCHESTER, MI 48307-1875
(947) 222-1667
(947) 222-1647
Mailing address
1000 W UNIVERSITY DR STE 207, ROCHESTER, MI 48307-1875
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
05/15/2026
Last updated
06/15/2026
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