Provider Demographics
NPI:1619322526
Name:MICHIGAN MAXILLOFACIAL SURGERY & IMPLANTS PC
Entity Type:Organization
Organization Name:MICHIGAN MAXILLOFACIAL SURGERY & IMPLANTS PC
Other - Org Name:GREATER MICHIGAN ORAL SURGEONS AND DENTAL IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LESNESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-934-3420
Mailing Address - Street 1:5150 FASHION SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-9434
Mailing Address - Country:US
Mailing Address - Phone:989-401-6591
Mailing Address - Fax:989-401-6596
Practice Address - Street 1:5150 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9434
Practice Address - Country:US
Practice Address - Phone:989-401-6591
Practice Address - Fax:989-401-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery