Organization
SUMMIT ORAL SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL LEE DDS (ADMINISTRATOR)
(313) 600-2188
Entity
Organization
Contact information
Practice address
19921 E JACKSON DR, INDEPENDENCE, MO 64057-1596
(313) 600-2188
Mailing address
19921 E JACKSON DR, INDEPENDENCE, MO 64057-1596
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
04/04/2026
Last updated
04/04/2026
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