Organization
ORAL AND FACIAL SURGEONS OF MICHIGAN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EVELYN M DAVIS (BILLING DEPT./ACCOUNTS)
(810) 632-0303
Entity
Organization
Contact information
Practice address
11525 HIGHLAND RD, SUITE 23, HARTLAND, MI 48353-2726
(810) 632-0303
(810) 632-7305
Mailing address
11525 HIGHLAND RD, SUITE 23, HARTLAND, MI 48353-2726
(810) 632-0303
(810) 632-7305
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190F37120
BCBS OF MI
MI
Enumeration date
08/24/2006
Last updated
07/21/2022
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