Provider Demographics
NPI:1558510537
Name:SEVEN OAKS PROFESSIONAL, PLLC
Entity Type:Organization
Organization Name:SEVEN OAKS PROFESSIONAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-393-1888
Mailing Address - Street 1:3226 HIDDEN TIMBER DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1598
Mailing Address - Country:US
Mailing Address - Phone:248-393-1888
Mailing Address - Fax:248-393-1890
Practice Address - Street 1:3226 HIDDEN TIMBER DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1598
Practice Address - Country:US
Practice Address - Phone:248-393-1888
Practice Address - Fax:248-393-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty