Organization
OAKLAND ORAL SURGERY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK F MOORES DDS (ORAL AND MAXILLOFACIAL SURGEON)
(734) 427-3366
Entity
Organization
Contact information
Practice address
31646 SCHOOLCRAFT RD, LIVONIA, MI 48150-1819
(734) 427-3366
(734) 427-0407
Mailing address
31646 SCHOOLCRAFT RD, LIVONIA, MI 48150-1819
(734) 427-3366
(734) 427-0407
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
JM16423
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P13950
MEDICARE GROUP PTAN
MI
01
—
P13950001
MEDICARE INDIVIDUAL PTAN
MI
01
—
P13950003
MEDICARE INDIVIDUAL PTAN
MI
01
—
P13950004
MEDICARE INDIVIDUAL PTAN
MI
Enumeration date
02/25/2009
Last updated
02/25/2009
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