Organization
THIRD COAST ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNIKA SCHOTT (FINANCIAL COORDINATOR)
(616) 583-7307
Entity
Organization
Contact information
Practice address
2119 64TH ST SW, BYRON CENTER, MI 49315-9409
(616) 217-3632
(616) 217-3634
Mailing address
2119 64TH ST SW, BYRON CENTER, MI 49315-9409
(616) 217-3632
(616) 217-3634
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811378508
NPPES
MI
Enumeration date
02/15/2022
Last updated
02/15/2022
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