Organization
SUMMIT ORAL & MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE M WINDISCH (BILLING SPECIALIST)
(586) 755-9340
Entity
Organization
Contact information
Practice address
29427 RYAN RD, WARREN, MI 48092-2203
(586) 755-9340
(586) 755-9341
Mailing address
29425 RYAN RD, WARREN, MI 48092-2203
(586) 755-9340
(586) 755-9341
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E07680
MEDICARE PTAN
MI
01
—
970E076800
BC
MI
Enumeration date
11/08/2006
Last updated
09/14/2009
Update your record
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