Organization
CENTRAL MICHIGAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOESPH VINCENT MAURO DDS (OWNER)
(517) 272-0886
Entity
Organization
Contact information
Practice address
231 W LAKE LANSING RD STE 200, EAST LANSING, MI 48823-8451
(517) 272-0886
(517) 272-0887
Mailing address
231 W LAKE LANSING RD STE 200, EAST LANSING, MI 48823-8451
(517) 272-0886
(517) 272-0887
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
JM012412
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5330109
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
07/11/2017
Last updated
07/21/2022
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