Provider Demographics
NPI:1497269492
Name:GREGORY C. MICHAELS D.D.S., M.S. ORAL & MAXILLOFACIAL SURGERY,INC.
Entity Type:Organization
Organization Name:GREGORY C. MICHAELS D.D.S., M.S. ORAL & MAXILLOFACIAL SURGERY,INC.
Other - Org Name:MICHAELS ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-654-6628
Mailing Address - Street 1:823 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2549
Mailing Address - Country:US
Mailing Address - Phone:740-654-6628
Mailing Address - Fax:740-654-6578
Practice Address - Street 1:823 N COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2549
Practice Address - Country:US
Practice Address - Phone:740-654-6628
Practice Address - Fax:740-654-6578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300194381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty