Provider Demographics
NPI:1235273152
Name:ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF MICHIGAN, P.C.
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-553-3280
Mailing Address - Street 1:32905 W 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3344
Mailing Address - Country:US
Mailing Address - Phone:248-553-3280
Mailing Address - Fax:248-553-2913
Practice Address - Street 1:32905 W 12 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3344
Practice Address - Country:US
Practice Address - Phone:248-553-3280
Practice Address - Fax:248-553-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F36264Medicare PIN
MI0P20890Medicare PIN