Organization
FACIAL SURGERY INSTITUTE, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK FARBOD MD,DMD,FACS,FRCS (MEDICAL DIRECTOR)
(906) 225-5959
Entity
Organization
Contact information
Practice address
1029 LINCOLN AVE, SUITE #4, MARQUETTE, MI 49855-2679
(906) 225-5959
Mailing address
1029 LINCOLN AVE, SUITE #4, MARQUETTE, MI 49855-2679
(906) 225-5959
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5520044
BLUE CROSS BLUE SHIELD
MI
Enumeration date
10/25/2012
Last updated
09/08/2020
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