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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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