Organization
ORAL AND MAXILLOFACIAL SURGERY SERVICES, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM L ERICKSON D.D.S. (OWNER)
(616) 977-5000
Entity
Organization
Contact information
Practice address
4500 CASCADE RD SE, SUITE #208, GRAND RAPIDS, MI 49546-3665
(616) 977-5000
(616) 977-0020
Mailing address
4500 CASCADE RD SE, SUITE #208, GRAND RAPIDS, MI 49546-3665
(616) 977-5000
(616) 977-0020
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
KE011553
MI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
KE011553
MI
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
KE011553
MI
Other
Enumeration date
07/25/2006
Last updated
09/11/2025
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