Organization
GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C.
Active
Parent organization
GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C.
Other names
Greater Michigan Oral Surgeons & Dental Implant Center, Oral and Maxillofacial Surgery, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C.
Authorized official
SAMANTHA A KERN (CREDENTIALING & BILLING)
(810) 424-0705
Entity
Organization
Contact information
Practice address
5417 GATEWAY CTR, FLINT, MI 48507-3980
(810) 424-0705
(810) 424-0750
Mailing address
5417 GATEWAY CENTRE BLVD., FLINT, MI 48507-3980
(810) 424-0705
(810) 424-0750
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
195256547
BLUE CROSS BLUE SHIELD
MI
05
—
2594587
—
MI
05
—
4045904
—
MI
05
—
4417670
—
MI
01
—
9752562480
BLUE CROSS BLUE SHIELD
MI
01
—
975256759
BLUE CROSS BLUE SHIELD
MI
Enumeration date
10/10/2006
Last updated
08/28/2024
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