Provider Demographics
NPI:1437399870
Name:OAKLAND ORAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:OAKLAND ORAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-476-0800
Mailing Address - Street 1:39595 W 10 MILE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2948
Mailing Address - Country:US
Mailing Address - Phone:248-476-0800
Mailing Address - Fax:248-476-5531
Practice Address - Street 1:39595 W 10 MILE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2948
Practice Address - Country:US
Practice Address - Phone:248-476-0800
Practice Address - Fax:248-476-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0120921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU78530Medicare UPIN
MIOM93350Medicare PIN
MIU50526Medicare UPIN
MIT82933Medicare UPIN
MI5636876Medicare PIN
MI5636238Medicare PIN