Provider Demographics
NPI:1528008042
Name:MICHIGAN ORAL AND MAXILLOFACIAL SURGEONS, P.C.
Entity Type:Organization
Organization Name:MICHIGAN ORAL AND MAXILLOFACIAL SURGEONS, P.C.
Other - Org Name:DOCTORS DALBERT W. FEAR, JR, ROGER P. HITCHCOCK & WILLIAM D. BAXTER,JR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FEAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:734-769-6524
Mailing Address - Street 1:2058 S STATE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4786
Mailing Address - Country:US
Mailing Address - Phone:734-769-6524
Mailing Address - Fax:734-769-6743
Practice Address - Street 1:2058 S STATE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4786
Practice Address - Country:US
Practice Address - Phone:734-769-6524
Practice Address - Fax:734-769-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI970H17622OtherBCBS GROUP NUMBER
MIJ801610OtherBCBS DENTAL GROUP #
MI0H17622Medicare ID - Type UnspecifiedGROUP MEDICARE ID