Provider Demographics
NPI:1619021862
Name:METROPOLITAN ORAL AND MAXILLOFACIAL SURGERY, P.L.L.C.
Entity Type:Organization
Organization Name:METROPOLITAN ORAL AND MAXILLOFACIAL SURGERY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GOFFAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD, MS
Authorized Official - Phone:810-733-5570
Mailing Address - Street 1:5080 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2923
Mailing Address - Country:US
Mailing Address - Phone:810-733-5570
Mailing Address - Fax:810-733-0221
Practice Address - Street 1:5080 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2923
Practice Address - Country:US
Practice Address - Phone:810-733-5570
Practice Address - Fax:810-733-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0106X, 204E00000X
MI1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1310702OtherUNITED CONCORDIA
MI0986425OtherHEALTH PLUS DR. GOFFAS
MIDB0981OtherMEDICARE RAILROAD
MIP59769OtherDR. HYDE BCN
MI0986834OtherHEALTH PLUS DR. HYDE
MI2901014309OtherDENTAMAX DR. HYDE
MIS1D8003860OtherBCBS DENTAL
MI1009797OtherDR. HYDE GLOBAL
MID143090OtherBCBS DENTAL DR. HYDE
MI2901014708OtherDENTAMAX DR. GOFFAS
MID147080OtherBCBS DENTAL DR. GOFFAS
MID143090OtherBCBS DENTAL DR. HYDE
MI0M99530Medicare PIN
MI1310702OtherUNITED CONCORDIA