Organization
MICHIGAN OMS P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS J BOURNIAS DDS (PRESIDENT)
(586) 228-9070
Entity
Organization
Contact information
Practice address
6022 W MAPLE RD STE 405, WEST BLOOMFIELD, MI 48322-4408
(248) 855-2006
(248) 855-0571
Mailing address
6022 W MAPLE RD STE 405, WEST BLOOMFIELD, MI 48322-4408
(248) 855-2006
(248) 855-0571
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021382
—
MI
05
—
2773480
—
MI
01
—
2901020355
STATE LICENSE NUMBER
MI
05
—
2990516
—
MI
05
—
2990552
—
MI
05
—
2990561
—
MI
05
—
3159052
—
MI
05
—
3203473
—
MI
05
—
4067429
—
MI
01
—
970F31085
GROUP NUMBER BCBSM
MI
01
—
NB015573
STATE LICENSE NUMBER
MI
Enumeration date
08/30/2006
Last updated
01/17/2024
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