Organization
LAKE MICHIGAN ORAL & MAXILLOFACIAL SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KEOUGH (CREDENTIALING REP)
(405) 848-7974
Entity
Organization
Contact information
Practice address
3950 HOLLYWOOD RD, 290, SAINT JOSEPH, MI 49085-9151
(405) 848-7974
(405) 848-0033
Mailing address
3000 UNITED FOUNDERS BLVD, 237, OKLAHOMA CITY, OK 73112-3958
(405) 848-7974
(405) 848-0033
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901018748
MI
Other
Enumeration date
08/05/2010
Last updated
08/05/2010
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up