GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C. (NPI# 1902993819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902993819 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C. |
| Other Organization Name | ORAL AND MAXILLOFACIAL SURGERY, P.C. |
| Practice Address |
5417gateway Centre Blvd. Flint MI 48507-3980 |
| Mailing Address |
5417 Gateway Centre Blvd. Flint MI 48507-3980 |
| Practice Telephone | 8104240705 |
| Practice Fax Number | 8104240750 |
| Mailing Telephone | 8104240705 |
| Mailing Fax Number | 8104240750 |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2014-08-11 |
| Authorized Official Name | MICHAEL S. FREY (OWNER/PRESIDENT) |
| Authorized Official Telephone | 8104240705 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | Y |
| Parent Organization Name | GREAT LAKES ORAL SURGERY AND IMPLANTS, P.C. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS BLUE SHIELD | 195256547 | 01 |
| MI | 2594587 | 05 | |
| MI | BLUE CROSS BLUE SHIELD | 975256759 | 01 |
| MI | 4045904 | 05 | |
| MI | 4417670 | 05 | |
| MI | BLUE CROSS BLUE SHIELD | 9752562480 | 01 |
| Other Name | Type Code |
|---|---|
| Oral and Maxillofacial Surgery, P.C. | Former Legal Business Name - Organization |
| Street Address |
5417GATEWAY CENTRE BLVD. |
| City | FLINT |
| State | MI |
| Zip Code | 48507-3980 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245847870 | Alexis Nichole Leach | Physician Assistant | 5494 South Dort Hwy, Flint, MI 48507 | 2020-09-28 |
| 1508330317 | Jeffrey Mark Funck | Registered Nurse | G-4443 Miller Road, Suite 100, Flint, MI 48507 | 2019-01-15 |
| 1861981292 | Lavonne L Alexander | Nurse Practitioner | 4500 S Saginaw St Ste 1875, Flint, MI 48507 | 2018-05-01 |
| 1760984348 | Melissa Dawn Hoffman | Psychologist | 5402 Gateway Centre Drive, Suite B, Flint, MI 48507 | 2018-02-28 |
| 1902327323 | Katee Mast | Case Manager/Care Coordinator | 110 Eldon Baker Drive, Flint, MI 48507 | 2017-07-06 |
| 1699228460 | Joshua Sinclair | Social Worker | 2442 E Maple Ave Ste 207, Flint, MI 48507 | 2016-07-28 |
| 1477903730 | Gracie Hunter | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1110 Eldon Baker, Flint, MI 48507 | 2016-06-17 |
| 1528412822 | Drita Gojcaj | Massage Therapist | 3426 Miller Road, Flint, MI 48507 | 2016-04-22 |
| 1629422100 | Ellen Makarewicz-ely | Massage Therapist | 3426 Miller Rd, Flint, MI 48507 | 2016-04-20 |
| 1700262722 | Katelyn Bailey | Nurse Practitioner | 1420 W Twelfth St, Flint, MI 48507 | 2015-07-31 |
| Find all providers in zip 48507 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568639433 | Robert C. Lesneski | Dentist | 5417 Gateway Ctr, Flint, MI 48507-3980 | 2008-05-10 |
| 1831232065 | Ronald Carey Stewart | Dentist | 2425 Welch Blvd, Flint, MI 48504-2998 | 2007-02-15 |
| 1811084726 | Michael S. Frey | Dentist | 5417 Gateway Centre Blvd., Flint, MA 48507-3980 | 2006-10-10 |
| 1619021862 | Metropolitan Oral and Maxillofacial Surgery, P.l.l.c. | Dentist | 5080 W Bristol Rd, Flint, MI 48507-2923 | 2007-01-23 |
| 1639266547 | Melvin J. Flamenbaum | Dentist | 5417 Gateway Centre Blvd., Flint, MI 48507-3980 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568080414 | Shawn J Kim | Dentist | 425 E Washington St Apt 811, Ann Arbor, MI 48104-2060 | 2020-07-08 |
| 1760008528 | Great Lakes Oral and Maxillofacial Surgery P.C. | Dentist | 2325 Summit Park Dr Ste D, Petoskey, MI 49770-8774 | 2020-06-17 |
| 1962969634 | Garfield Road Dental - 1 | Dentist | 41781 Garfield Rd, Clinton Township, MI 48038-1964 | 2019-02-28 |
| 1477903904 | Abed Yakan | Dentist | 2700 Martin Luther King Jr. Blvd., 358, Detroit, MI 48208-2576 | 2016-06-15 |
| 1811378508 | Christopher Niquette | Dentist | 2119 64th Street Sw, Byron Center, MI 49315-4931 | 2015-06-18 |
| 1528446069 | Douglas David Orzel | Dentist | 9021 N Rodgers Ct Se Ste A, Caledonia, MI 49316-7650 | 2015-05-17 |
| 1013321165 | Raymond James Hanna | Dentist | 3766 Elder Rd S, West Bloomfield, MI 48324-2534 | 2014-06-17 |
| 1831536861 | Claude Charles Lerose Jr. | Dentist | 20675 Mack Ave, Grosse Pointe Woods, MI 48236 | 2013-05-31 |
| 1821433566 | Curtis Cardon | Dentist | 5957 Harvey St Ste 200, Norton Shores, MI 49444-9737 | 2013-05-08 |
| 1043568694 | Nick Leone Dds PC | Dentist | 28018 Harper Ave., St. Clair Shores, MI 48081-1562 | 2012-08-29 |
| Find all providers with the same taxonomy | ||||
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| 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.