Provider Demographics
NPI:1356865174
Name:I CARE ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC
Entity Type:Organization
Organization Name:I CARE ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC
Other - Org Name:I CARE ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS ,MD
Authorized Official - Phone:248-363-5900
Mailing Address - Street 1:2900 UNION LAKE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3550
Mailing Address - Country:US
Mailing Address - Phone:248-363-5900
Mailing Address - Fax:248-363-4917
Practice Address - Street 1:2900 UNION LAKE RD STE 105
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-3550
Practice Address - Country:US
Practice Address - Phone:248-363-5900
Practice Address - Fax:248-363-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010192561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty