Organization
KEYSTONE ORAL AND MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY E KASPER DDS (OWNER)
(586) 914-0093
Entity
Organization
Contact information
Practice address
36975 UTICA RD, SUITE 106, CLINTON TOWNSHIP, MI 48036-1685
(586) 226-2801
(586) 226-1519
Mailing address
36975 UTICA RD, SUITE 106, CLINTON TOWNSHIP, MI 48036-1685
(586) 226-2801
(586) 226-1519
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901017390
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E04308
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/19/2014
Last updated
10/27/2014
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