Organization
GREAT LAKES ORAL AND MAXILLOFACIAL SURGERY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT SCOTT SHEPERD DDS (CEO/PRESIDENT)
(231) 487-1020
Entity
Organization
Contact information
Practice address
2325 SUMMIT PARK DR STE D, PETOSKEY, MI 49770-8774
(231) 487-1020
Mailing address
2325 SUMMIT PARK DR STE D, PETOSKEY, MI 49770-8774
(231) 487-1020
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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