ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WESTERN MICHIGAN PLC (NPI# 1598772626) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598772626 |
| Entity Type | Organization |
| Organization Name | ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WESTERN MICHIGAN PLC |
| Practice Address |
2140 Lake Michigan Dr Nw Grand Rapids MI 49504-4785 |
| Practice Telephone | 6167919600 |
| Practice Fax Number | 6167919603 |
| Mailing Telephone | 6167919600 |
| Mailing Fax Number | 6167919603 |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2010-04-12 |
| Authorized Official Name | J MARK DOMIN (MEMBER) |
| Authorized Official Telephone | 6167919600 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE RAILROAD | CC0861 | 01 | |
| MI | MEDICARE GROUP NUMBER | 0N13750 | 01 |
| BCBSM BCN/CHOICE | 970D111530 | 01 |
| Street Address |
2140 LAKE MICHIGAN DR NW |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49504-4785 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972789949 | Victor H Mastaglio | Dentist | 2140 Lake Michigan Dr Nw, Grand Rapids, MI 49504-4785 | 2008-01-21 |
| 1720173529 | Lonny E Zietz | Dentist | 2140 Lake Michigan Dr Nw, Grand Rapids, MI 49504-4785 | 2006-10-04 |
| 1053406728 | Paul Jeffrey Brooks | Dentist | 2140 Lake Michigan Dr Nw, Grand Rapids, MI 49504-4785 | 2006-10-04 |
| 1891880654 | James Mark Domin | Dentist | 2140 Lake Michigan Dr Nw, Grand Rapids, MI 49504-4785 | 2006-10-04 |
| 1316032139 | Steven W Schultz | Dentist | 2140 Lake Michigan Dr Nw, Grand Rapids, MI 49504-4785 | 2006-10-04 |
| 1609961374 | Brant A Erbentraut | Dentist | 2140 Lake Michigan Dr Nw, Grand Rapids, MI 49504-4785 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477049518 | Mark Contreras | Nurse Practitioner | 72 Sheldon Blvd Se # 130, Grand Rapids, MI 49504 | 2018-07-02 |
| 1205338753 | Kelli Marie Selby | Physical Therapist | 235 Wealthy, Grand Rapids, MI 49504 | 2018-03-01 |
| 1871094474 | Kymiri Lyn Coles | Physical Therapist | 1000 Edison Ave Ne, Grand Rapids, MI 49504 | 2018-02-28 |
| 1881132744 | Courtney Glinka | Behavior Technician | 1149 Butterworth St Sw, Grand Rapids, MI 49504 | 2017-02-10 |
| 1649650300 | Alyson Renee Vela | Social Worker | 1256 Walker Ave Ne, Grand Rapids, MI 49504 | 2015-06-08 |
| 1508258500 | Grand Rapids Natural Health | Nutritionist | 638 Fulton Street W., Grand Rapids, MI 49504 | 2015-02-27 |
| 1144622598 | Robert Mclaren | Physical Therapist | 2807 Lake Michigan Dr Nw Ste 1, Grand Rapids, MI 49504 | 2014-09-17 |
| 1972854339 | Beth Ellen Gregory | Registered Nurse | 1956 Walker Avenue Northwest, Grand Rapids, MI 49504 | 2012-09-26 |
| 1588914147 | Unlimited Alternatives | Community/Behavioral Health | 282 Leonard, Grand Rapids, MI 49504 | 2012-09-11 |
| 1386912178 | Michael Allen Crawford | Pharmacist | 800 West Leonard Nw, Grand Rapids, MI 49504 | 2011-12-07 |
| Find all providers in zip 49504 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760900120 | Cynthia A Rider Dmd Pllc | Oral & Maxillofacial Surgery | 2545 Spring Arbor Road, Suite 202, Jackson, MI 49203 | 2017-09-06 |
| 1881792786 | James W Lepczyk | Oral & Maxillofacial Surgery | 31100 Telegraph, Suite 100, Bingham Farms, MI 48025 | 2006-09-21 |
| 1558472332 | Richard F Scott Dds Ms PC | Oral & Maxillofacial Surgery | 203 S Zeeb Road, Suite 101, Ann Arbor, MI 48103 | 2006-08-31 |
| 1922115633 | Nick Leone | Oral & Maxillofacial Surgery | 28018 Harper Avenue, St Clair Shores, MI 48081 | 2006-08-25 |
| 1831113125 | Jeffery Mcfadden | Oral & Maxillofacial Surgery | 33111 W. Seven Mile Rd., Livonia, MI 48152 | 2006-07-27 |
| 1215950100 | William S Bloom | Oral & Maxillofacial Surgery | 11300 East Thirteen Mile Road, Warren, MI 48093 | 2006-07-25 |
| 1609809250 | Richard Peter Bartling | Oral & Maxillofacial Surgery | 3011 Abigail Ln, Midland, MI 48640 | 2006-07-08 |
| 1710949953 | Robert Harry Burke | Oral & Maxillofacial Surgery | 2260 S Huron Pkwy, Ann Arbor, MI 48104-5151 | 2006-04-04 |
| 1497728380 | Brian H Cohen | Oral & Maxillofacial Surgery | 2120 Monroe St, Dearborn, MI 48124-2943 | 2006-02-10 |
| 1659355063 | Donald Gary Wolford | Oral & Maxillofacial Surgery | 22811 Mack Ave, L1, St Clair Shores, MI 48080-2021 | 2005-11-30 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49504 |
Please comment or provide details below to improve the information on ORAL & MAXILLOFACIAL SURGERY ASSOCIATES OF WESTERN MICHIGAN PLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.