Organization
UPPER MICHIGAN ORAL & MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD STANCHINA (PRESIDENT)
(906) 228-7173
Entity
Organization
Contact information
Practice address
1250 WILSON ST, SUITE 101, MARQUETTE, MI 49855-4454
(906) 228-7173
(906) 228-2916
Mailing address
1250 WILSON ST, SUITE 101, MARQUETTE, MI 49855-4454
(906) 228-7173
(906) 228-2916
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
J14145
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124726184
—
MI
Enumeration date
04/08/2008
Last updated
11/01/2016
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